QHORT JALKS 



WITH 



Young Mothers 



Charles Gilmore Kerley.MD. 






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Sbott {Talks 
Witb Moving /Iftotbers 

ON THE MANAGEMENT OF INFANTS 
AND YOUNG CHILDREN 



BY 

Charles Gilmore Kerley, M.D. 

Professor of Diseases of Children, New York Polyclinic Medical School 

and Hospital; Attending Physician to the New York Nursery and 

Child's Hospital; Assistant Attending Physician to the Babies' 

Hospital, New York; Consulting Physician, New York 

Home for Crippled and Destitute Children; Consulting 

Pediatrist, Greenwich Hospital; Consulting Pedi- 

atrist, Savilla Home, N. Y.; Consulting 

Pediatrist, Volunteer Hospital, N. Y. 



THIRD EDITION, REVISED AND ENLARGED 
ILLUSTRATED 



G. P. PUTNAM'S SONS 

NEW YORK & LONDON 

Gbe Ifcnic&erboc&er press 

1915 



«*£ 






Copyright, 190 i 

by 

CHARLES GILMORE KERLEY 

Copyright, 1909 

BY 

CHARLES GILMORE KERLEY 
Copyright, 1915 

BY 

CHARLES GILMORE KERLEY 



$,* 



Ube Iftnfcfeerbocfeer press, "Hew Ifforft 



SEP 16 1915 

CI.A411541 



TO 
L. EMMETT HOLT, M.D. 

Clinical Professor of Diseases of Children in the College of Physicians 
and Surgeons (Columbia University) New York 

THIS WORK IS INSCRIBED 

IN RECOGNITION OF HIS HIGH PROFESSIONAL ATTAINMENTS AND 

ENTHUSIASM IN PROMOTING THE STUDY OF DISEASES 

OF CHILDREN, AND IN GRATEFUL APPRECIATION 

OF MANY ACTS OF KINDNESS 



PREFACE TO THIRD EDITION 

THE aim of this book is to help the 
young mother to a closer acquaint- 
ance with and a more intelligent apprecia- 
tion of the nature and demands of the 
little life entrusted to her care. 

In its preparation the author has kept 
in mind and has endeavored to answer 
the personal questions of many thought- 
ful young mothers. Under management are 
given such suggestions as may. be carried out 
by the mother or nurse and in no way do 
away with the necessity of a physician. 

Suggestions relating to medical treat- 
ment are intentionally avoided. A mother 
should know all the details of the child's 
feeding, clothing, bathing, and airing, and 
what to do in an emergency. She should 
also be able to recognize symptoms of ill- 
ness and appreciate their significance. She 
is not supposed to be skilled in the use 
of drugs. 



CONTENTS 






PAGE 


Adenoids ...... 


131 


Appetite ;..... 


137 


Artificial — bottle — feeding 


61 


Baskets for early exercise 


312 


Baths ....... 


III 


The cold douche . 


112 


Tub-baths for fever 


114 


Basin bathing for fever . 


114 


Bathing for comfort in hot weather 


114 


Mustard bath .... 


115 


Brine bath 






115 


Soda bath 






116 


Bran bath 






116 


Starch bath 






116 


Hot bath 






116 


Bed-wetting . 






277 


Bites of animals 






. 300 


Bites of insects 






. 301 


Boils . 






, 240 


Bronchitis 






. 166 


Burns . 






. 300 


Care of the breasts and nipples 


. 48 


Care of the genitals 


. 280 


Painful mictui 


ition, 


circumcision 


. 280 



Vlll 



Contents 



Chicken-pox 

Children's parties 

Cleanliness . 

Clothing to be provided 

Cold hands and feet 

Cold in the head (coryza) 

Colic .... 

Condensed milk 

Constipation . 

Management in the breast-fed 
Management in the bottle-fed 
Management in older children 

Convulsions .... 

Cough ..... 
Chronic cough 

Croup — catarrhal, diphtheritic 

Crying .... 

Cuts, bruises, and sprains 



Dentition .... 

The breast-fed 

The well-managed bottle-fed 

The badly fed 
Diet after the sixth year 
Diet during illness 

The art of feeding in illness 
Diphtheria .... 
Disinfection after contagious diseases- 
fumigation .... 



196 



Contents 


ix 




PAGE 


Don'ts 


320 


Drug-giving 


308 


Earache ..... 


117 


Eczema ..... 


226 


The strait- jacket 


228 


The mask .... 


230 


Enlarged tonsils . . . 


135 


Excitement ..... 


287 


Feeding after the first year 


71 


Fever ...... 


243 


First aid to the baby 


299 


Fissures of the anus 


239 


Flies and mosquitoes 


296 


Food formulas .... 


323 


Beef -juice .... 


323 


Beef, mutton, and chicken broth 


324 


Scraped beef .... 


324 


Egg-water 


324 


Oatmeal jelly .... 


324 


Wheat jelly and barley jelly 


• 324 


Barley-water .... 


324 


Rice-water .... 


325 


Dextrinized barley-water 


325 


Oatmeal-water 


• 325 


Imperial granum-water . 


• 325 


Whey 


• 325 


Junket ..... 


. 326 



x Contents 

Food formulas — Continued 

Cornstarch Pudding 

Soft Custard .... 
Foreign bodies in the ear and nose . 
Foreign bodies swallowed 

General Instructions 

German measles .... 

Germs ...... 

Glands ..... 

Acute enlargement of the glands of the 
neck ..... 

Chronic enlargement of the glands of 
the neck .... 

Grippe ..... 

Habits ..... 

Ear-pulling .... 

The "pacifier" habit 

Masturbation 
Habitual vomiting. 
Hand-i-hold mit .... 

Head lice — pediculi capitis 

Height in inches from birth to sixth year 

Hives ...... 

How the child should be fed . 
How to examine the throat 
How to lift the baby 



Indoor airing 



326 
326 
303 
303 

322 
180 
297 
223 

223 

224 

255 

141 
144 
142 

145 
100 
144 
241 

11 
232 

81 
148 

12 

310 



Intertrigo 
Kissing 



Contents xi 



PAGE 
234 

288 



Malaria ...... 245 

Malnutrition and marasmus . . .101 
Maternal nursing . . . . .16 

The diet 24 

The bowel function . . .26 
Air and exercise . . . .27 
Regularity in nursing . . .28 
Signs of successful nursing . . 29 
Signs of unsuccessful nursing . . 29 
Signs of insufficient nursing . . 35 
Management of abnormal milk condi- 
tions 35 

Mixed feeding . . . .38 

Maternal conditions under which nurs- 
ing is forbidden .... 39 
Conditions which may temporarily 
produce an unfavorable effect upon 
the breast-milk, but not necessitate 
the discontinuance of nursing . 39 

Conditions which call for temporary 

discontinuance of nursing . . 41 

Care of the nipples . . . . 41 

Giving of water .... 42 

Frequency of nursings ... 43 

Measles ...... 190 



xii Contents 



PAGE 



Milk-crust ...... 233 

Milk for travelling 93 

Milk in infants' breasts . . . .136 

Mumps ...... 181 

Night terrors . . . . .314 

Nose-bleed ...... 302 

Nursery-maids . . . . .128 

Patent medicines ..... 305 

Pneumonia . . . . . .172 

Premature and congenitally weak infants . 217 
Prickly heat . . . . . .237 



Retention of urine ..... 


282 


Rheumatism ..... 


254 


Rickets ...... 


249 


Scales for weighing .... 


315 


Scarlet fever ..... 


177 


Scurvy ...... 


251 


Sick-room for contagious diseases — qua- 




rantine ..... 


193 


Disinfectant drugs .... 


195 


Sleep ....... 


290 


Sprue and thrush ..... 


149 


Sterilization and pasteurization of milk . 


57 


Stomatitis, or sore mouth 


152 



Contents 


xiii 




PAGE 


Summer diarrhoea 


105 


Bowel irrigation 


109 


Prevention .... 


1 10 


Reduction of food . 


no 


Cleanliness .... 


III 


Summer resorts .... 


306 


Taking cold .... 


154 


Temperature, and how to take it 


136 


The baby-basket and its contents . 


I 


The care of the eyes 


119 


The contagious diseases 


175 


The daily outing .... 


309 


The delicate child .... 


198 


Normal development 


199 


Abnormal development . 


199 


Management 


200 


Regular weighings necessary 


202 


Feeding delicate infants . 


203 


Diet after the first year . 


206 


Baths ..... 


208 


Fresh air . . 


209 


Sleep . • . 


211 


The nursery . 


211 


Influence of climate 


213 


Clothing . . . 


214 


As to the nature of the clothing 


214 


Exercise. . . 


215 


Midday nap .... 


■ 215 



XIV 



Contents 



The Delicate Child — Continued 




Entertainment 


• 215 


Education .... 


. 216 


The exercise pen .... 


• 317 


The first duty to the child 


5 


The hair 


. 127 


The normal throat 


• 147 


The nursery ..... 


12 


The nursing-bottle and nipple. 


• 59 


The proprietary foods 


. 88 


The uses of proprietary dried-r 


nilk 


foods ..... 


. 89 


Proprietary foods to which h 


•esh 


cows' milk is added 


90 


The proprietary beef foods 


. 92 


The selection of milk 


• 53 


The skin in health 


. 225 


The teeth 


. 124 


The care of the teeth 


• 125 


The permanent teeth 


. 126 


The trained nurse .... 


129 


The weight of the well baby . 


9 


The well baby .... 


7 


The wet-nurse .... 


• 43 


Tonsillitis ..... 


. 163 


Tuberculosis .... 


. 246 


Vaccination ..... 


• 274 


Vomiting ..... 


• 99 



Contents 


XV 




PAGE 


Weaning ...... 


50 


Care of breasts during weaning 


52 


When to send for the doctor . 


298 


Whooping-cough .... 


183 


Worms 


284 


Round-worms 


284 


Thread-worms 


285 


Tape-worms .... 


286 



ILLUSTRATIONS 



Baby-Basket .... 


2 


Nipple-Shield .... 


42 


English Breast-Pump 


50 


Freeman Pasteurizer 


• 58 


Nursing Bottle and Nipple 


60 


The Chapin Dipper 


66 


Hand-I-Hold Mit .... 


. 144 


The Throat Examination 


. 149 


Cold Compress .... 


164 


The Holt Croup-Kettle 


. 170 


Crib Prepared for Steam Inhalation 


■ 171 


The Electrotherm .... 


. 219 


The Breck Feeder 


222 


Strait-Jacket .... 


229 


Strait-Jacket in Position 


229 


Mask Pattern .... 


230 



xviii Illustrations 



PAGE 



Mask in Position . ... . .231 

The Bulb Syringe 274 

Basket for Early Exercise . . .313 
Scoop and Platform Scales for Weighing . 316 
Exercise Pen. ..... 318 



SHORT TALKS 
WITH YOUNG MOTHERS 



SHORT TALKS 
WITH YOUNG MOTHERS 



THE BABY-BASKET AND ITS 
CONTENTS 

(See Fig. I.) 

A BASKET in which all the toilet necessi- 
ties for the baby may be kept together 
will be found a great convenience when the 
time for their use arrives. 

To be provided : 

A good-sized pin-cushion and pins. 

Puff-box and puff. 

Soap-box containing Castile soap. 

Infant's hair brush and fine comb. 

Eight ounces of a saturated solution of 
boracic acid for mouth and eyes. 

One-half pound of absorbent cotton. 

A package of wooden toothpicks. 

A bottle of white vaseline. 



The Baby-Basket 

A bath thermometer. 

One yard of plain sterile gauze. 

Plenty of soft old linen. 

Six of the best baby towels. 




FIG. I. BABY-BASKET 



A white eiderdown blanket one and one- 
half yards long. 

One pair of small scissors. 



Clothing 3 

A package of nickel-plated safety-pins 
(three sizes) . 

CLOTHING 

Clothing required at birth. — The infant at 
birth requires practically the same clothing, 
winter or summer — three flannel bands, to 
be torn the desired length and width accord- 
ing to the size of the baby. This allows for 
a band in use, one to be laundered and one 
for emergency. The band is sewed on every 
day, after baby's bath. Have the needle 
ready for use in a small cushion especially 
for the purpose, and be sure to replace the 
needle when finished. We are very certain 
if the band is put on in this way that baby 
is not crying because pins are sticking in 
him. 

Three silk and wool (or cotton and wool) 
shirts, high neck and long sleeves (lighter 
weight for a summer infant). 

Three dozen cotton diapers. 

Three flannel slips with button and button 
holes on each shoulder. This type of gar- 
ment prevents unnecessary handling of the 
child. 



4 Clothing 

Six plain muslin slips. 

At six months. — From the third month 
on, according to the season, the child may be 
put in short clothes. The little slips can be 
cut short and a few new ones added. Eight 
in all are sufficient. 

Three stockingette night slips, one easily 
washed every morning. 

Three flannel petticoats, and stockings 
to cover the legs, as they have been kept 
very warm up to this time. In winter a silk 
and wool (or cotton and wool) stocking is 
advisable. A woven band is now used instead 
of the strips of flannel. The shirts are the 
same, except if the summer months have 
arrived the baby needs low neck cotton shirts 
instead of woolen ones. 

The number of diapers the baby requires 
should now begin to diminish, for at regular 
intervals he is held on a small chamber to 
urinate. If his bowels move regularly he 
will seldom have a soiled napkin. 

At the first year. — At about this age the 
child will begin to stand, and he must have 
shoes to support his ankles. Rompers will 
give him freedom and save on the laundry. 
As soon as he is sufficiently trained (about 



First Duty to the Child 5 

18 months), drawers should replace the 
diapers. 

Laced shoes are best for a walking child, 
but cannot be procured for a small baby. 
When out of doors in winter the child should 
have his ears well covered, and a bonnet 
with an interlining should be used. A thin 
sweater is a convenient garment to use under 
the coat on very cold days. The child should 
never go out when the thermometer is under 
1 5° F. A fine piece of cheese-cloth may be 
made to fit the baby carriage, fastened on 
the hood, and this will guard against dust 
and the high winds. 

The out-of-door clothing is dependent en- 
tirely upon the season of the year and with 
the sudden changes which take place in the 
climate definite rules can not be laid down. 
Mothers are obliged to rely upon their own 
judgment, or that of experienced friends. 
As a general proposition it may be said that 
infants are very apt to be overclad, particu- 
larly during the hot weather. 

THE FIRST DUTY TO THE CHILD 

With the severing of the umbilical cord 
the child begins an independent existence. 



6 First Duty to the Child 

It is made to cry, the eyes and mouth receive 
attention, when it is wrapped in a soft, warm 
blanket and placed out of draughts until it 
can be given further attention. During the 
excitement of the occasion and the needs of 
the mother the baby is sometimes neglected, 
often with serious consequences. I once 
saw, with another physician, a fatal case of 
pneumonia in a child four days old, the dis- 
ease being due in all probability to neglect. 
It must not be forgotten that the baby has 
been suddenly transported into an entirely 
different sphere of action from that to which 
he is accustomed, and we must make the 
change as easy for him to bear as possible. 
As soon as the nurse can devote her attention 
to the baby he should be gently and thor- 
oughly oiled with liquid albolene or sweet oil. 
This is to be followed later by a sponge bath 
with lukewarm water and Castile soap. The 
stump of the cord should be dusted with some 
dry antiseptic powder and wrapped in dry, 
plain sterile gauze. The cord, particularly 
at its junction with the abdomen, should be 
thoroughly dusted twice a day. When it 
falls off, the parts should be kept dusted and 
dry until cicatrization is complete. The 



The Well Baby 7 

following powder has proven most satis- 
factory in my hands : 

Salicylic acid, 15 grains. 
Powdered starch, 1 ounce. 
Powdered oxide of zinc, 1 ounce. 

THE WELL BABY 

In order to appreciate disease or failure in 
proper growth and development, it is neces- 
sary to know what constitutes a well baby. 
The well baby grows steadily, shows an in- 
crease in weight of from five to six ounces a 
week, the muscles are firm, the skin clear, 
and the eyes bright. When hungry he makes 
it known by crying lustily. At the com- 
pletion of the feeding he gives evidence of 
comfort by drowsiness, or by falling asleep. 
There are two or three soft yellow stools 
daily. After the second month the well baby 
appreciates a moderate amount of attention, 
and is attracted to bright objects and pleas- 
ant faces. His sleep is restful, and he wakes 
good-natured unless he is hungry. It is 
not to be understood that the well baby 
cries only when hungry. He often cries 
while being undressed, when the clothing 



8 The Well Baby 

is uncomfortable, when objectionable people 
appear before him, or when suffering from 
pain. 

At the fourth or fifth month he should be 
able to hold his head erect without support; 
from the sixth to the seventh month — at 
this time the first tooth is usually cut — he 
acquires the power of sitting up without 
assistance; from the ninth to the tenth 
month he begins to creep, and from the 
twelfth to the eighteenth month he learns 
to walk alone. A very few children walk 
alone before the twelfth month; the great 
majority, however, are from fifteen to eigh- 
teen months before this important feat is 
accomplished. There is nothing to be gained 
and much harm may be done by parents 
favoring early walking. When the child 
learns to walk unaided, it is usually safe to 
allow him to continue, unless he is very 
heavy. A child four or five pounds over 
weight should be carefully watched and the 
walking prevented to any extent until he is 
seventeen or eighteen months of age. Early 
walking in these heavy children is very apt 
to produce flat feet, knock-knee, or bowed- 
legs. 



Weight of the Well Baby 9 
THE WEIGHT OF THE WELL BABY 





BOYS 


GIRLS 


Average weight a 


t birth 


7-55 lbs. 


7.16 lbs. 


' three months 


11.75 " 


11.5 " 


<« n 1 


1 six months 


16. " 


15.5 " 


«i << < 


' nine months 


18. " 


17.75 " 


«< 11 < 


1 twelve months 


20. " 


19.8 " 


<« << 4 


' eighteen months 


22.8 " 


22. " 


(i (i 1 


' two years 


26.5 " 


25.5 " 


n a t 


1 three years 


31.5 ;; 


30. " 


tt a t 


1 four years 


35 « 


34. " 


<< a 1 


' five years 


41.2 " 


39-8 " 


it Hi 


1 six years 


45.1 " 


43-8 " 



Weighing the baby. — Every child under 
one year of age should be weighed once a 
week. The very weak and delicate and 
those who are being put through a new 
course of dietetic treatment on account of 
failure in growth, should be weighed two or 
three times a week. 

Gain in weight. — An infant is doing fairly 
well who gains on an average four ounces a 
week, ten months in the year. Such a child, 
however, needs careful watching. If he 
gains from six to ten ounces a week, we are 
perfectly satisfied with his progress. 

The weight chart. — The use of the weight 



io Weight of the Well Baby 

chart I do not advise. Such a chart, while 
recommended by many well-known writers, 
has been the cause of serious trouble. The 
mother and nurse wish the baby's weight 
chart to make a good showing — to show 
something phenomenal if possible — for the 
admiration of relatives and friends. Some 
perfectly well, vigorous babies increase in 
weight slowly, but a gain of only four or five 
ounces a week — below the standard of her 
neighbor or the normal weight line on the 
chart — makes a very unsatisfactory chart, 
and the mother in consequence begins to 
worry, fearing that her baby is not being 
properly nourished. Worry and anxiety 
have caused the milk of hundreds of mothers 
to fail, and rendered further nursing impos- 
sible. If the babe is wet-nursed and the 
chart does not show a large gain, the mother 
is unhappy, the family generally is dissatisfied, 
the wet-nurse sulks, and, fearing lest she 
lose her position, her milk soon fails and 
she is unable to nurse the baby. If the baby 
is bottle-fed, there is a strong tendency to 
overfeed him in order to make a pretty chart, 
and as a result the child is made ill. 

The gain in weight is much less in summer 



Height in Inches from Birth n 

than during the cooler months. I have seen 
many children in perfect health pass through 
July and August without gaining an ounce; 
but with the arrival of cooler weather they 
will surely make up for the time lost. 

Early loss in weight. — There is usually 
a decided loss in weight the first four days 
of life. This loss — from a quarter to a half 
pound — will usually be regained in five or six 
days if the child is properly fed. 

Weight at age of one and two years. — At 
the end of the first year the child should 
weigh two and one-half times as much as at 
birth. There should be a gain of about seven 
pounds during the second year. 

HEIGHT IN INCHES FROM BIRTH TO 
SIXTH YEAR 



At birth 


6 months 


12 months 


Boys, 20.6 
Girls, 20.5 


254 
25 


29 

28.7 


18 months 


Two years 


Three years 


Boys, 30 
Girls, 29.7 


32.5 
32.5 


35 
35 



12 The Nursery 

Four years Five years Six years 

Boys, 38 41.7 44.1 

Girls, 38 41.4 43.6 

HOW TO LIFT THE BABY 

A baby should be lifted by placing one 
hand under the buttocks and the other under 
the head. Until the fifth or sixth month is 
reached, a child should never be raised with 
the head unsupported. 

THE NURSERY 

The nursery should be the largest and best 
ventilated room in the house. In a city 
home it is best to have it on the third or 
fourth floor with a southern exposure. In 
apartments, quiet and the possibility of free 
ventilation and sunlight must be considered 
in selecting the room. For the sake of quiet 
the nursery should not communicate with 
the sleeping-rooms of older children. 

Air capacity of sleeping-room. — In placing 
children in sleeping-rooms or in a nursery, 
or in estimating the capacity of hospital 
wards for children, it is to be remembered 



The Nursery 13 

that at least one thousand cubic feet of air- 
space should be allowed to each child. 

The floor of the nursery should not be 
carpeted. A hard-wood floor is best. If 
this is not possible, covering the floor with 
oil-cloth or linoleum is always possible. 
This can be cleaned with a damp cloth every 
day. A broom should never be used in a 
nursery. Paint or hard finish on the walls 
is preferable to paper. There should be at 
least two windows and an open fireplace. If 
possible, the bath-room should be connected 
with the nursery, to be used not only for 
bathing the child but as a " changing room." 
The child's napkins should not be changed 
in its living-room if it can be avoided. It is 
needless to say that napkins should never be 
dried in the nursery. 

Heating. — Steam heat as ordinarily used 
to-day is the least desirable means of heat- 
ing, on account of its uncertainty. In many 
New York apartments of the better class the 
fires are banked at 10 p.m.; the temperature 
when the child retires is from 70 to 8o° F. 
by five or six o'clock in the morning a fall to 
from 50 to 6o° F. has taken place. Such a 
change in the temperature with the tendency 



14 The Nursery 

of children to kick off the bed-clothes ex- 
plains many cases of tonsillitis and bron- 
chitis. The temperature of the nursery 
should be kept as even as possible. When 
for any reason this cannot be controlled, it 
is best to have two means of heating, so that 
when one fails the other may be used. The 
open-grate fire or a small wood-stove is best. 
Gas ought never to be employed as a means 
of heating a child's sleeping-room, on account 
of the rapid exhaustion of the oxygen which 
results from its use. 

Furnishings. — The furniture of the nursery 
should be of the plainest. Hard-wood chairs 
and tables with enamel or brass cribs or bed- 
steads should be used. There should be no 
article of furniture or furnishings in a nursery 
that cannot be washed. There should be in 
the bath-room or in some room adjoining, a 
pail containing some disinfectant solution, 
such as carbolic acid, one tablespoonful to 
two gallons of water, in which the napkins 
are placed as soon as soiled. 

There should be two shades at each win- 
dow, a light and a dark shade, so that it will 
be possible to darken the room during the 
sleeping time, as well as to exclude the early 



The Nursery 15 

morning light, which is the usual cause of too 
early waking. Babies should be taught to 
sleep until at least six o'clock in the morning. 
This is far better for the child and also for 
the mother if she occupies the same room. 
The unnecessary habit of an early waking at 
four or five o'clock will in most instances 
readily be broken by keeping the room dark. 

Ventilation. — The nursery should have 
suitable means for ventilation. For this pur- 
pose, aside from the fireplace, I have found 
the window board of no little service. It 
can be made of any width. Ordinarily, I 
have it made about four inches wide. It is 
sawed so as to fit tightly under the lower 
sash. This leaves an open space correspond- 
ing to the width of the board between the 
upper and lower sash, and allows the entrance 
of a current of air which is directed upward. 

Room temperature. — There should be a 
thermometer in every child's living-room or 
nursery. It should register from 68° to 70 
F. by day and from 50 to 6o° F. by night. 
The nursery should be given an hour's airing 
twice a day. The child should sleep alone 
in its crib. It should not sleep with an adult 
or an older child. The old-fashioned cradle 



1 6 Maternal Nursing 

in which generations have been rocked may 
be an interesting heirloom, but under no 
circumstances should it be removed from its 
place in the garret. 

MATERNAL NURSING 

Writers on this subject are very apt to 
state that the ability of the mother, par- 
ticularly among the well-to-do, to fulfil this 
most important function is surely decreasing. 
This may have been a true statment a dec- 
ade ago; at the present time, however, I am 
sure it is erroneous. In my own medical 
life I have seen a change for the better, par- 
ticularly during the past ten years. The 
young mother of to-day is better able to nurse 
her offspring than was her own mother. I 
attribute this to the fact that the youth of 
the present day are more vigorous, more 
nearly normal individuals than were those 
of a decade ago. The inability to perform 
the nursing function so that it will be success- 
ful has always been attributed to the mother 
per se. This, I think, is an error. Not 
every breast-milk for two or three weeks 
after parturition is ideal, as I have found by 



Maternal Nursing 17 

the examinations of hundreds of them. If a 
child is born with a generally enfeebled vital- 
ity, it keenly feels any slight abnormality in 
the milk, or it may not be able to digest per- 
fectly normal milk; in either event, the milk 
disagrees and the nursing is discontinued. 
Breast-milk during the first two or three 
weeks of the infant's life is produced under 
conditions which are unfavorable — condi- 
tions which do not indicate the possibilities 
of the breast as a secreting organ. Follow- 
ing, as it does, upon the stress of confinement, 
it is not indicative of what may be possible 
later when the customary life and daily habits 
are resumed. Repeatedly I have found a 
very high fat or a high proteid, or both, dur- 
ing the first week or two, entirely corrected 
later without interference. This condition at 
the time was considered sufficiently serious 
to warrant the discontinuance of nursing on 
the part of a weakly infant, while in a vigor- 
ous infant it would be entirely ignored. 

Influence of the daily life. — The change 
which enables more mothers successfully to 
nurse their infants is due to two causes — 
more vigorous fathers and mothers and more 
vigorous offspring. Following this line of 



1 8 Maternal Nursing 

reasoning, the more normal the mother, the 
better able is she to perform this normal 
function. That this is the case is due, I 
believe, to the fact that growing girls and 
young women are leading more hygienic 
lives than formerly. The making of golf, 
bicycle and horseback riding, boating, and 
automobiling popular and fashionable — in 
short, the taking of girls out-of-doors and 
keeping them there a considerable portion 
of the day — has worked a marvellous change 
for the better, both physically and mentally. 
A neurotic mother makes the poorest pos- 
sible milk-producer. Proportionate to the 
population, there are fewer neurasthenics 
among the young women to-day than there 
were twenty years ago, and there will be still 
fewer twenty years hence. At the present 
time the timid, retiring young woman of the 
neurasthenic type is not popular in her set. 
It is a fortunate thing for the future of the 
human race, at least for that portion of it 
which resides in the United States, that the 
young woman has transferred her allegiance 
from the crochet and embroidery needle to 
the golf club. 

Better living practice pervades all classes. — 



Maternal Nursing 19 

It may be said that our argument holds only 
with the wealthy or the well-to-do. Imita- 
tion is one of the strongest characteristics 
of the human race, and this tendency in 
America to outdoor hygienic living pervades 
all classes. Saturday half -holidays, the ex- 
cursions and outings afforded by reduced 
rates of transportation, are much more 
popular than they were ten years ago. Food 
is better selected and better prepared, 
owing to increased knowledge on the part 
of the people as to what constitutes proper 
nutrition. These are facts, in spite of the 
sensational novelists and magazine-writers. 

The teaching of right living. — A feature 
which marks an important advance in the 
right direction is the establishment of a de- 
partment in dietetics and food economics in 
the New York Training School for Teachers. 
The Dean, Dr. James E. Russell, in establish- 
ing this course, is producing benefits which 
reach farther than he realizes. The students 
are taught food values, food preparation, 
and food economics, which consist in pro- 
viding for a given amount of money the most 
nutritious food in its most attractive form. 
Hundreds of teachers are sent out from this 



20 Maternal Nursing 

institution every year to take their places of 
usefulness as instructors of the young in all 
portions of the country. Each has learned 
something of food values, and better still 
each has had impressed upon him or her the 
importance of the proper nutrition of a 
growing child. They are taught that, without 
this, the best possible type of adult cannot 
be produced. As a result of such instruction 
they will be of far greater service in their 
fields of labor, for not only can they teach 
what is laid down in the books, but, what 
is equally if not more important, they are 
competent to teach those under their care 
how to live; and those who live properly, 
grow properly, following out the maxim of 
Herbert Spencer that "the first requisite for 
success in life is to be a good animal; and to 
be a nation of good animals is the first con- 
dition of national prosperity." It may be 
thought that we have wandered far from our 
subject — maternal nursing, but such is not 
the case; for conditions which relate to this 
important function, even remotely, demand 
our respectful consideration. The food and 
care of the growing girl have the most inti- 
mate bearing upon her future life, and if she 



Maternal Nursing 21 

is to be called upon to perform the most 
important function of womanhood, she surely 
has the right to demand that she receive dur- 
ing her girlhood proper preparation, which 
heretofore has too often been denied her. 

The duty of the physician. — It is not 
pleasant to criticise physicians; but friendly 
criticism should always be welcomed. The 
family physician does not, in a great majority 
of instances, fulfil his function, or extend 
his field of usefulness to its full capacity, his 
conception of duty too often including only 
the sick. Unsought advice as to the feeding 
and daily habits of a child's life, I find, are 
usually welcomed and appreciated by mothers. 
In practically every instance, according to 
my observation, errors in a child's manage- 
ment are due to ignorance. Mothers, no 
matter what their station in life, are glad to 
do what is for the best interests of their 
children when it is made clear to them. It is 
the duty of the physician to take the mother 
into his confidence and explain to her the 
reasons for the line of action advised. When 
she appreciates the reason for certain pro- 
cedures, I find that she is far more apt to 
follow them. 



22 Maternal Nursing 

Possibilities under right management. — I 
am confident from observations upon many 
cases that if I could have the physical direc- 
tion of ten average girls in any station in life, 
provided that they could have the benefit 
of fresh air and good food from infancy to 
adolescence, successful nursing mothers could 
be made out of eight of them. 

Requirements for successful nursing. — Cer- 
tain rules of life having a direct bearing on 
nursing lead us nearer the ideal and may en- 
able one who otherwise could not nurse her 
child to do so successfully. These require- 
ments, it will be seen, are laid along common- 
sense lines and cause no hardship or mental 
distress — one of the chief requirements of 
a nursing woman being that she shall be 
mentally normal. 

There are few conditions, in which we are 
called to act, so variable and so uncertain 
as is the production of breast-milk. Breast- 
milk is one of the most precious substances. 
It is invaluable, unless we can put a value on 
human life. 

Successful nursing age. — The most success- 
ful nursing age is between the twentieth and 
thirty-fifth years. I have, however, seen it 



Maternal Nursing 23 

successfully carried on in a girl of fourteen, 
in a woman of fifty- two, and in the much- 
abused society girl, while I have seen it fail 
absolutely in peasant women fresh from the 
fields of Hungary and Bohemia. I have 
seen those in whom at first the nursing was 
most unsatisfactory develop into perfect 
nurses. 

Duration of nursings. — Some mothers will 
be able to carry on the nursings for only two 
months; others, three, five, seven, or nine 
months. In my experience, whether in out- 
patient or in private practice, it is extremely 
rare for the breast-milk to be sufficient for 
the child after the ninth month. 

The following can be laid down as nursing 
axioms : 

A diet similar to what the mother was 
accustomed to before the advent of mother- 
hood should be taken. 

There should be one bowel evacuation 
daily. 

There should be from three to four hours 
daily spent in the open air with exercise 
which does not fatigue. 

There should be at least eight hours' sleep 
out of every twenty-four. 



24 Maternal Nursing 

There should be absolute regularity in 
nursing. 

There should be no worry and no excite- 
ment. 

The mother should be temperate in all 
things. 

The diet. — I have many times been con- 
sulted by nursing mothers because the nurs- 
ing was unsuccessful or a partial failure, and 
have found that their diet has been restricted 
to an extreme degree. To put on a greatly 
restricted diet a robust young mother who 
has always eaten bountifully of a generous 
variety of foods is one of the best means of 
curtailing the quantity and lowering the 
quality of her milk-supply. When asked to 
prescribe a diet I tell them to eat practically 
as they were accustomed to before the advent 
of pregnancy and motherhood. That this 
particular vegetable or that particular fruit 
should be forbidden, on general principles is 
a fallacy. Food that the patient can digest 
without inconvenience is a safe food so far 
as the nursing is concerned, as may readily 
be determined in any given case. If a wide 
range of diet is prescribed in some individuals, 
a plain, more or less restricted diet is desirable 



Maternal Nursing 25 

in others. Many a wet-nurse who has been 
carefully selected, who to the best of our 
judgment should prove satisfactory, utterly 
fails in a few days to fulfil the duties of the 
office for which she was chosen. In not a 
few instances the failure is due to a very full 
diet of unusual articles of food, the exist- 
ence of which, in many instances, she never 
dreamed of. Indigestion and constipation 
follow, and both the nurse and the baby are 
made ill and the woman's usefulness ceases. 
A woman who has lived and been well on the 
diet and food found in the home of the labor- 
ing man, whether in the city or country, will 
make a far better wet-nurse on this diet than 
if she indulges in food to which she is entirely 
unaccustomed. The diet of a nursing mother, 
then, should in general be as above stated. 

Nursing is a perfectly normal function, 
and a mother should be permitted to carry 
it out along only natural lines. Inasmuch 
as there are two lives to be provided for 
instead of one, more food, particularly of a 
liquid character, may be taken than she may 
have been accustomed to. It is my custom 
to advise that milk be given freely. A glass 
of milk may be taken in the middle of the 



26 Maternal Nursing 

afternoon, and eight ounces of milk with 
eight ounces of oatmeal or cornmeal gruel at 
bedtime, if it does not disagree. Our only- 
evidence that a food is not disagreeing is the 
condition of the digestion. When any article 
of food disagrees with the mother, or if she 
is convinced that it disagrees, whether or 
not such is really the case, the food should 
be discontinued. In a general way, milk in 
quantities not over one quart daily, eggs, 
meat, fish, poultry, cereals, green vegetables, 
and stewed fruit constitute a basis for selec- 
tion. The method of preparation for the 
different meals is not arbitrary. 

The bowel function. — A very important 
and often neglected matter in relation to 
nursing is the condition of the bowels. There 
must be one free evacuation daily. For the 
treatment of constipation in nursing women 
I have used different methods in many cases. 
The dietetic treatment does not promise 
much. For here, again, manipulation of the 
diet may interfere with the milk production. 
Three methods are open to use: massage, 
local measures, and drugs. Massage is avail- 
able in comparatively few cases. Local 
measures consist in the use of enemas or 



Maternal Nursing 27 

suppositories. Every nursing woman under 
my care is instructed to use an enema at bed- 
time if no evacuation of the bowels has taken 
place during the previous twenty-four hours. 
Many out-patients, in whom constipation 
is very prevalent, indulge in excessive tea- 
drinking, taking often from one to two gallons 
of tea daily. In such patients, where an 
absolute discontinuance of the tea-drinking 
is often impossible and not absolutely neces- 
sary, I usually allow two cups a day. When 
a laxative is necessary, it should be prescribed 
by a physician. 

Air and exercise. — Outdoor life and exer- 
cise are desirable here as they are under all 
other conditions. In a nursing woman, with 
her added responsibility, they are doubly so. 
In order to get the best results, exercise or 
work should so be adjusted as not to reach 
the point of fatigue. The mother whose 
nights are disturbed should be given the 
benefit of a midday rest of an hour or two. 
She should have at least eight hours' sleep 
out of every twenty -four. Certain annoy- 
ances, anxieties, and worries are inseparable 
from the life of every child-bearing woman. 
It should be our duty, however, to explain 



28 Maternal Nursing 

to the mother and to other members of the 
family that an important element in satis- 
factory nursing is a tranquil mind. During 
the lactation period she should be spared all 
unnecessary care and petty annoyances. 

Regularity in nursing. — The breast which 
is emptied at definite intervals invariably 
works better than does one which is not, not 
only as regards the quantity, but the quality 
of the milk as well ; so that system in breast- 
feeding is almost as essential to milk-produc- 
tion as to its digestion and assimilation. 

The use of one bottle a day. — After it is 
demonstrated that the nursing is progressing 
satisfactorily as proved by the satisfied, 
thriving child, I begin with one bottle-feeding 
daily. The advisability is obvious; in case 
of illness of the mother, if she is called away 
from home, or if, for any reason, the child 
cannot have the breast, the feeding is pro- 
vided for. Another advantage is that it 
gives the mother needed freedom from re- 
straint. She is thus enabled to have the 
benefit of a change of scene. Amusements 
and recreations which the invariable nursing 
period denies her can be indulged in. As a 
result of this greater freedom, she is able 



Maternal Nursing 29 

to supply better milk and to continue nursing 
longer than if tied continually to the baby, 
no matter how fond she may be of it. 

Signs of successful nursing. — The child 
shows a gain of not less than four ounces 
weekly. This is the minimum weekly gain 
which may safely be allowed. When a nurs- 
ing baby remains stationary in weight or 
makes a gain of but two or three ounces a 
week, it means that something is wrong, and 
it will usually, but not invariably, be found 
in the milk supply. When the baby is nursed 
at proper intervals and the supply of milk is 
ample and of good quality, he is satisfied at 
the completion of the nursing. If he is under 
three months of age, he falls asleep after ten 
or twenty minutes at the breast. When the 
nursing period again approaches, he becomes 
restless and unhappy, crying lustily if the 
nursing is delayed. When the breast is 
offered, he takes it greedily. The stools are 
yellow and number from two to three daily. 
The weekly gain in weight under such con- 
ditions is usually from six to eight ounces. 

Signs of unsuccessful nursing. — Theoreti- 
cally, every normal breast baby should be a 
thriving, well baby. That such is not the 



30 Maternal Nursing 

case is an unfortunate fact. The standard 
established for a well baby is not upheld here. 
When the supply of milk is scanty the child 
remains long at the breast and cries when he 
is removed. He shows signs of hunger before 
the nursing hour arrives. A cause of failure 
in breast-feeding, and probably the most 
frequent cause, is a scanty milk-supply. The 
chief nutritional elements in mother's milk 
are: fat, 3 to 4 per cent.; sugar, 7 per cent.; 
proteid, 1.5 per cent. Failure may be due 
to a marked disproportion of these elements, 
which may cause sufficient indigestion and 
resulting loss in weight to necessitate the 
discontinuance of nursing. Thus there may 
be a high fat — from 5 to 6 per cent. ; or very 
low fat — from 1 to 1.5 per cent. In the high- 
fat cases there will usually be diarrhoea with 
green, watery stools. The child strains a 
great deal and there are green stains on many 
of the napkins. In high-fat cases there is 
also regurgitation or vomiting of sour mate- 
rial. Low fat means deficient nourishment 
and may cause constipation. Sugar is rarely 
a cause of trouble in nursing babies. It sel- 
dom varies, ranging from 5 to 7 per cent, in 
the great majority of breast-milks. Young 



Maternal Nursing 31 

children, further, have a marked toleration 
for it. The proteid of mother's milk is the 
most frequent cause of nursing difficulties. 
Like the fat, it may so be decreased that 
nutritional disorder may be induced in the 
patient, or it may be very much increased; 
the latter being usually the cause of colic or 
constipation in otherwise healthy nursing 
infants. In such infants curds may be found 
in the stools, the passage of which is always 
accompanied by a great deal of gas. The 
milk may contain the normal percentage of 
fat, sugar, and proteid, but be scanty in 
amount. Instead of the four or five ounces 
to which the child is entitled, he may get but 
one or two ounces. Whether or not the 
quantity is sufficient can be determined by 
weighing the baby before and after each 
nursing, for twenty-four hours. One ounce 
of breast-milk practically weighs one ounce 
avoirdupois. The quality or strength is 
determined by an examination of the milk 
itself by the physician. Before nursing, the 
child is put in the scales without undressing 
him and the weight noted. He is allowed to 
nurse fifteen minutes. He is then removed 
from the breast and weighed. 



32 Maternal Nursing 

Amount of milk required. — A child under 
one week should have gained from I to 2 
ounces; at three weeks of age, 2 to 3 ounces; 
four to eight weeks of age, 3 to 4 ounces ; eight 
to sixteen weeks of age, 4 to 5 ounces; sixteen 
to twenty-four weeks of age, 5 to 6 ounces; 
six to nine months of age, 6 to 8 ounces ; nine 
to twelve months of age, 8 to 9 ounces. 

Of course arbitrary limits cannot be fixed 
as to the quantity. Stationary weight or 
loss in weight with a dissatisfied child usually 
means defects in quantity which are readily 
proved by the weighing. To be fed at the 
breast may also cause the child to suffer from 
an excess of good milk, in which event there 
will be vomiting or regurgitation, usually 
associated with colic. When this overfeed- 
ing continues, dilatation of the stomach 
develops, vomiting becomes habitual, the 
child loses in weight, and the breast-milk is 
said not to agree, and often, unfortunately, 
the baby is weaned. This has been the out- 
come in scores of cases. When there is 
habitual vomiting and colic in a nursing baby, 
two things are to be done — the baby must be 
weighed before and after nursing, and the 
milk must be examined. 



Maternal Nursing 33 

I have repeatedly treated children for 
indigestion who were entirely relieved by 
shortening the nursing period. Weighing 
the baby at intervals of from three to five 
minutes and noting the gain has shown that 
the three or four ounces which may be the 
child's stomach capacity was obtained in 
two, three, or five minutes, the excess which 
the child took over this amount being the 
cause of his trouble. Given a free, full breast 
and a vigorous nurser, and one ounce will be 
taken in one minute. When the nursing 
"gait" is established, a child should be kept 
up to the schedule. There are few more 
pernicious teachings than that a baby should 
be allowed to nurse when he wants to and as 
long as he wants to. The idea that a nurs- 
ing infant will take no more than is good for 
him is the fruit of inexperience. Recently a 
mother consulted me in regard to putting 
her one-month-old baby on the bottle, as he 
had many green stools, cried a great part of 
his waking hours, and weighed but a few 
ounces more than at birth. Her milk was 
supposed to be "too strong" for the child. 
An examination of the breast and a talk with 
the mother satisfied me that the breast-milk 



34 Maternal Nursing 

was not at fault. An examination of the 
milk proved it to be good average milk — 3.5 
per cent, fat, 6 per cent, sugar, 1.45 per cent, 
proteid. A one-day's test by weighing was 
decided upon. He was allowed to nurse one 
minute and rest one minute. During the 
resting period he was weighed. Weighing 
and resting him in this way, it was found 
that in three minutes he got from 3 to 3^ 
ounces of milk. The nursing was then re- 
duced to three minutes on one breast and 
five minutes on the other, which was the 
"slower" breast of the two. Every sign of 
indigestion promptly disappeared after this 
change. The stools became normal and the 
infant made a satisfactory gain in weight of 
one ounce daily. 

Necessity for milk examination. — The quan- 
tity may be suitable for the age of the 
child, he may not vomit or show a sign 
of indigestion, and yet he may not thrive. 
In such a case an examination or repeated 
examinations of the milk at intervals of two 
or three days will usually show that it is poor, 
below the normal perhaps in both fat and 
proteid. Such a case occurred in the New 
York Infant Asylum. A Swedish woman 



Maternal Nursing 35 

was admitted with an infant two months old 
in fair condition. She had an abundance of 
milk and asked for a foster-child, so great 
was her discomfort from the excessive flow 
of milk. The weekly weighings of the chil- 
dren soon revealed that there was no growth, 
and both children upon examination showed, 
after a few weeks, developing rickets. The 
milk was then examined and was found defi- 
cient — fat 1.2 per cent., sugar 5 per cent., and 
proteid 0.73 per cent. 

Signs of insufficient nursing. — The baby 
remains long at the breast, perhaps one-half 
to three-quarters of an hour. When re- 
moved, he is restless and uncomfortable. 
After a short time, in an hour or less, he is 
very hungry and demands frequent nursings 
day and night. 

Management of abnormal milk conditions. 
— When it is found that the breast-milk is too 
strong or too weak, or when the normal ratios 
of fat, sugar, and proteid are not maintained, 
it may be possible to increase or diminish the 
milk strength. It may also be possible to 
increase either the fat or the proteid when 
desirable. The heavy milk will usually be 
found in mothers who are robust, who eat 



36 Maternal Nursing 

heartily, and who take but little exercise. 
In such a mother, the prescribing of a plain 
diet, allowing red meat but once a day, dis- 
continuing the malt liquors or wine — which 
it will often be found that she is taking, — and 
directing that she walk a mile or two a day, 
will frequently bring the milk to digestible 
proportions. In some cases, however, this 
will not be successful, and the colic, consti- 
pation, and vomiting continue, even though 
the quantity obtained at each nursing is 
within normal limits. In some mothers it 
will be impossible to change the mode of life, 
except perhaps as to the discontinuance of 
alcohol. When such conditions prevail, the 
mother's milk may be modified by giving 
from one-half to one ounce of boiled water 
or plain barley-water before each nursing. 
This is a procedure to which I frequently 
resort. One teaspoonful of lime-water added 
to one ounce of water before each nursing has 
made the breast-milk agree when otherwise 
it would have been impossible. When the 
milk is deficient both in fat and proteid, a 
diet composed largely of red meat, poultry, 
fish, rye bread, or whole-wheat bread, oat- 
meal, cornmeal, with two or three pints of 



Maternal Nursing 37 

milk daily, will often be followed by an in- 
crease both in fat and proteid. The use of 
alcohol in moderate amounts, in the form of 
malt liquors or wine, will usually increase 
the fat. I have frequently seen it advance 
2 per cent, in from two to three days. Disap- 
pointments in improving the quantity or 
quality of the breast-milk, however, are 
frequent. 

In addition to the one bottle which, for 
reasons above mentioned, is given early in 
the child's life, I find it necessary at the sev- 
enth month to add an extra bottle or two. 
Usually at this time the proteid in human 
milk begins to diminish in quantity, and as 
this is the most important nutritional ele- 
ment, an insufficient quantity at this rapidry 
growing period of life is a matter of no little 
importance. At the twelfth month, with 
very few exceptions, my nursing babies are 
weaned from necessity. At this age exclu- 
sive nursings, if one considers the best in- 
terests of the child, are practically out of 
the question. Out of many thousands of 
mothers I recall but one instance where a 
mother was able successfully to nurse her 
child after the twelfth month. This re- 



38 Maternal Nursing 

markable woman, the mother of six children, 
had nursed every one of them exclusively 
and successfully up to the fifteenth or the 
eighteenth month. 

Mixed feeding. — With a diminution in the 
amount of milk secreted, the breast milk, 
must, of course, be supplemented by modi- 
fied cow's milk. This method of feeding is 
usually successful. If the mother of a six- 
months-old baby can satisfactorily nurse 
him three times in twenty-four hours, he is 
given, in addition, three bottle-feedings in 
the twenty-four hours, in this way supple- 
menting the mother's milk. It is best when 
using mixed feedings to alternate the breast 
and the bottle. The modified milk strength 
should be that which is suitable for the aver- 
age child of his age. (See Infant Feeding, 
page 65.) In beginning the use of cow's 
milk, however, it must be remembered that 
at first a weaker strength must be used than 
the child will require for growth, this weaker 
food being necessary in order gradually to 
accustom him to the change of food. If too 
strong a cow's-milk mixture is given at first, 
it will be very apt to disagree, causing colic 
and vomiting. Later, when the child has 



Maternal Nursing 39 

become accustomed to the new food, a 
stronger mixture may be given. When a 
mother cannot give her infant at least two 
satisfactory breast-feedings daily, it is better 
to wean the child. 

Maternal conditions under which nursing 
is forbidden. — When the mother has tuber- 
culosis in any of its various forms or mani- 
festations, whether it involves the glands, 
the joints, or the lungs, breast-feeding is to 
be forbidden. In epilepsy and syphilis nurs- 
ing is likewise forbidden. In nephritis and 
malignant disease of any nature, and in 
chorea, nursing should be discontinued. 
Women who are rapidly losing weight should 
not continue nursing their infants. In case 
of serious illness of any nature, such as 
typhoid fever, pneumonia, or diphtheria, 
and upon the advent of pregnancy, nursing 
should be stopped. 

Conditions which may temporarily pro- 
duce an unfavorable effect upon the breast-milk, 
but not necessitate the discontinuance of nurs- 
ing. — The advent of the first menstruation 
period particularly, and in some cases of every 
menstruation period, is attended with an 
attack of colic or indigestion on the part of 



40 Maternal Nursing 

the child, rarely sufficient, however, to neces- 
sitate the discontinuance of the nursing even 
for a single day. 

Factors influencing the mental conditions 
of the mother, such as anger, fright, worry, 
shock, distress, sorrow, or the witnessing of 
an accident, may affect the milk secretion 
sufficiently to cause no little discomfort to 
the child, and oftentimes the temporary 
lessening of the flow for a day or two. The 
influence of the mental state upon the char- 
acter of the milk was early brought to my 
attention while resident physician at the 
Country Branch of the New York Infant 
Asylum. In this institution there were 
usually about two hundred nursing mothers, 
the majority of them from the lower walks 
of life, at least 95 per cent, of the infants be- 
ing illegitimate. The necessity of placing a 
considerable number of these mothers in 
wards, and their living thus in close contact, 
gave rise to rather frequent disputes, and 
not infrequently to fistic encounters of a 
decidedly vigorous character. After a par- 
ticularly active disturbance, several nursing 
infants in the ward would be taken suddenly 
ill, usually with vomiting, diarrhoea, and 



Maternal Nursing 41 

fever. When two or more infants were thus 
discovered ill, we soon learned to know the 
cause when inquiry or evidence furnished by- 
hasty inspection of the mother showed that 
she had been particularly active in the affair. 
A small proportion of the mothers were from 
the better walks of life. Letters of forgive- 
ness or reproach or visits of a like nature from 
fathers, mothers, or sisters, have brought 
many a sick baby to my attention and caused 
me many anxious moments. 

Conditions which call for temporary dis- 
continuance of nursing. — During an acute 
illness with fever, such as indigestion, ton- 
sillitis, and minor illnesses of a like nature, 
nursing should be discontinued for a day or 
two. When the infant is removed from the 
breast, it should be our effort to maintain 
the flow of milk. This is best done by empty- 
ing the breast with a breast-pump (page 50) 
at the usual nursing period until the time 
arrives when the nursing may be resumed. 
In such conditions the advantage of having 
the baby accustomed to one bottle a day 
will at once be appreciated. 

Care of the nipples. — Six hours after de- 
livery or confinement, the nipples should be 



42 Maternal Nursing 

washed with a saturated solution of boric 
acid and the child put to the breast and nurs- 
ing attempted. After this, the attempts at 
nursing should be repeated 
every four hours, although 
the milk does not appear 
in the breasts until from 
forty-eight to seventy-two 
hours after the birth of the 
child. Colostrum may be 
present, which is useful as 
a laxative and may satisfy 
the child. A further ad- 
vantage of the nursing at 
fig. 2. nipple-shield this time is that it grad- 
ually accustoms both the 
nipple and the infant to what will be required 
of them later. Immediately after the nurs- 
ing the nipple should be carefully washed 
with a saturated solution of boric acid and 
thoroughly but gently dried. A baby should 
never be allowed to nurse on a cracked or fis- 
sured nipple. For this very painful condition 
a nipple-shield (Fig. 2) should always be used. 
Giving of water. — From one-half to one 
ounce of a 1 per cent, solution of milk-sugar 
should be given the infant every two hours 




The Wet-Nurse 43 

until the milk appears in the breast. Other- 
wise there will be unnecessary loss in weight 
and perhaps a high degree of fever due to 
inanition. 

If the child is restless and uncomfortable, 
it is safe to conclude that he is thirsty, and 
one ounce of the sugar-water will usually 
satisfy him. With the commencement of 
nursing, accustom the baby to getting his 
food at regular intervals. 

Frequency of nursings. — The new-born 
infant is entitled to seven nursings in twenty- 
four hours. From 6 a.m. to 10 P.M., inclu- 
sive, there should be six nursings. There 
may be one nursing at 2 or 3 a.m. As the 
child becomes older less frequent nursings 
are required. The following table will be 
found useful in this connection : 



Third day to the twelfth week 7 nursings. 

Third to the seventh month 6 

Seventh to the twelfth month 5 

THE WET-NURSE 

We are called upon to select a wet-nurse 
under various conditions. In a few families, 



44 The Wet-Nurse 

particularly in those who have had disastrous 
feeding experiences, we are asked that no 
attempts at artificial feeding be made, but 
that a wet-nurse be engaged in advance of 
the confinement so as to be ready when the 
time for her service arrives. Usually, how- 
ever, our minds turn to the wet-nurse when 
nutrition by other methods is a failure. It 
is well to remember in this connection that 
it is not wise to postpone our resort to the 
wet-nurse too long — until every chance of 
her being of assistance has passed. It may 
take a few days' observation or but a single 
glance at one of these difficult feeding cases 
for us to decide whether a wet-nurse must 
be secured. Certain it is that in a few 
cases we cannot do without them. I see 
perhaps two or three cases a year, usually 
in consultation, in which I insist that further 
attempts at artificial feeding be discon- 
tinued because of the reduced condition of 
the patient. 

Age of the wet-nurse. — In the selection of a 
wet-nurse the age during which nursing is 
most successfully carried on is to be remem- 
bered. Other things being equal, a wet-nurse 
should not be under twenty-two or over 



The Wet-Nurse 45 

thirty-five years of age. The peasant women 
of the continent of Europe make the best 
wet-nurses. 

Type of woman required, — A woman 
should not be selected as a wet-nurse without 
a thorough examination both of herself and 
of her infant. She must be free from skin 
diseases, tuberculosis, and syphilis. Whether 
she is stout or thin, tall or short, amounts to 
little. Neither can we place much reliance 
on the size of her breasts. Although full, 
firm breasts and prominent nipples are de- 
sirable, the best indication as to her nursing 
ability is the condition of her baby. For this 
reason it is best not to select a woman before 
her baby is four weeks old, for by that time 
his physical condition will indicate with 
considerable accuracy the kind of food he 
has been getting. The age of the wet- 
nurse's milk need not correspond with the age 
of the patient for whom she is engaged. As 
far as age is concerned, a breast-milk from 
four weeks to three months old will answer 
for any infant. 

The results attending the first few days of 
wet-nursing are often most disappointing. 
The radical change which takes place in the 



46 The Wet-Nurse 

nursed habits of life, the leaving of her own 
child to the care of others, sometimes pro- 
duces nervous conditions which may have 
a decidedly unfavorable influence upon her 
milk. So before arriving at the conclusion 
that she will not answer in a given case, she 
should have time to adjust herself to the 
changed conditions. 

Diet of the wet-nurse. — Many a good wet- 
nurse has been ruined, so far as her usefulness 
as a milk-producer is concerned, by over- 
indulgence at the table. She has been accus- 
tomed to a very plain diet and some work, 
which necessarily means exercise. Upon as- 
suming her new office she is temporarily 
the most important member of the household, 
next to the baby, and articles of food are 
supplied to which she is entirely unaccus- 
tomed and of which she eats plentifully. 
The result is an attack of indigestion with 
fever, the baby is made ill, and the usefulness 
of the wet-nurse in the family ceases. These 
women usually do best upon a plain diet of 
meat, poultry, fish, vegetables, cereals, and 
milk. If they are accustomed to taking 
beer, one bottle daily may be permitted. 
Coffee may be allowed to the extent of one 



The Wet-Nurse 47 

cup daily, and of tea not more than two cups 
should be allowed. 

The bowel function. — Women of this class 
are almost invariably neglectful of the bowel 
function, so that this must be attended to. 
One free evacuation should take place daily. 
As a rule, the wet-nurse has been accustomed 
to work and will be more contented and 
happy when her time is occupied. Being 
out-of-doors from three to four hours a day 
is of decided advantage to every nursing 
woman. If she possess sufficient intelligence 
to take the baby for his outings, she should 
be allowed to do so. For the comfort of the 
family, it is wise not to let a wet-nurse know 
her full value. When she feels that she is 
indispensable, trouble is apt to follow from 
one source or another. 

One bottle daily. — It is particularly neces- 
sary, therefore, that babies that are wet- 
nursed should be given one bottle-feeding 
daily as soon as they are able to take care 
of it. The wet-nurse will then realize that 
she can be dispensed with in case of miscon- 
duct, or if she leaves at an hour's notice 
the child can be given the bottle until another 
nurse is secured. In the great majority of 



48 Care of the Breasts and Nipples 

my cases it has not been necessary to con- 
tinue the wet-nursing after the children are 
seven months of age, for by this time they 
can usually be fed on the bottle. Of course, 
unless her nursing proves unsatisfactory, a 
wet-nurse should not be dismissed at the 
commencement of or during the summer. 

CARE OF THE BREASTS AND NIPPLES 

After nursing is well established the baby 
should be nursed at three hour intervals dur- 
ing the day. If he sleeps between 10 p.m. 
and 6 A.M. do not wake him. One feeding at 
2.30 A.M. is required by a few children up to 
the third month; the great majority, how- 
ever, do better without it. Before and after 
each nursing the mother's nipples should be 
gently washed with a saturated solution of 
boracic acid, using either clean old linen or 
absorbent cotton. The nipples should be 
thoroughly dried after the washing. 

Cracked and fissured nipples. — Nursing 
is often most painful on account of cracks 
and fissures in the nipples. These are very 
apt to occur if the parts are neglected, and 
the resulting pain when the child nurses is 



Care of the Breasts and Nipples 49 

unbearable, necessitating sometimes the dis- 
continuance of the breast-feeding. The baby 
should never be allowed to touch a cracked 
or fissured nipple, and a nipple-shield (see 
Fig. 2) should be used until the parts are 
healed. Some babies take very unkindly to 
the nipple-shield, and often_ a great deal of 
patience must be exercised before they can 
be taught its use. If the shield suggested 
does not answer, others may be tried. The 
breast should never be allowed to become 
hard or painful. If the child does not take 
enough to keep the breasts soft a breast- 
pump should be used to remove the re- 
mainder. For this purpose, the so-called 
English breast-pump (see Fig. 3) is the best. 
With the first rush of milk to the breasts it 
is often very difficult to prevent hard, pain- 
ful nodules from forming in the glands. The 
free use of the breast-pump and massage with 
warm oil, if properly carried out, will prevent 
the formation of an abscess. 

When the breasts are large and pendulous, 
a support consisting of a bandage firmly 
applied around the chest will often afford 
much comfort and prevent serious trouble. 
In addition to the use of the nipple-shield, 



50 



Weaning 



the cracked nipple should be washed with 
a saturated boracic-acid solution after each 
nursing, and dried, when 
a soothing ointment may- 
be applied on old linen; 
such an ointment, com- 
posed of ichthyol fifteen 
grains, vaseline one-half 
ounce, oxide-of-zinc oint- 
ment one-half ounce, 
has given most satisfac- 
tory results. The oint- 
ment should be care- 
fully removed with warm 
sweet-oil and the nipple 
washed in alcohol before 
the next nursing. When 
fig. 3., English breast- ^e fissures are healed, 

PUMP ,« • , 

the nursing may be re- 
sumed, allowing the child for a few days to 
take the nipple every second or third nurs- 
ing, thus gradually accustoming the nipples 
to the rough usage. 

WEANING 

When is the nursing baby to be given other 
food, or how long can the breast be relied 




Weaning 51 

upon to furnish the child its sole nourish- 
ment? If the mother, unassisted, is able to 
nourish her infant completely until it is seven 
months of age, she is doing remarkably well. 
There are very few nursing mothers who can 
pass that period without assistance. Per- 
haps one or two bottle-feedings a day may 
suffice. In many cases the milk will fail 
about the seventh month, and absolute wean- 
ing be necessary. Granting, however, that 
the child is thriving on the breast alone, or 
doing satisfactorily on the breast with only 
two daily feedings, at what age should the 
weaning take place? I have known just one 
mother out of several thousand who could 
nurse her child to the child's advantage after 
twelve months had passed. I have seen 
many pronounced cases of malnutrition and 
rickets due directly to prolonged nursing. 
Indigestion and diarrhoea are often the out- 
come of prolonged breast-feeding. 

The weaning in health should begin not 
later than the twelfth month. It is best 
accomplished gradually by substituting 
bottle-feeding for nursing, giving only one 
bottle the first day, two the second, three the 
third, and so on until in a week or ten days 



52 Weaning 

weaning is complete. In case the child is 
ill we may be obliged to wean at once, 
when bottle-feeding is substituted for the 
breast, but the milk formula corresponding 
to his age should not be given. To a child 
six months of age give the three-months' 
formula; a child nine months of age should 
receive the six-months' formula. A gradual 
increase to the formula suggested for a child 
the age of the patient may be made if all 
goes well. After the ninth month it is often 
possible to feed from a cup, which is then to 
be preferred to bottle-feeding as a substitute 
for the breast. 

Care of breasts during weaning. — When 
the breast-feeding is carried on the usual 
length of time — from nine to twelve months, 
— the process of weaning ordinarily causes 
little or no discomfort. All that is usually 
required is to press out enough of the milk to 
relieve the patient as often as the breast 
becomes painful, which may not be more than 
two or three times a day. When the weaning 
is necessarily abrupt, no little discomfort may 
result. If there is a free flow of milk, which 
is apt to be the case when the weaning must 
take place in the early nursing period, tightly 



The Selection of Milk 53 

bandaging the breasts is required. When 
localized hardened areas occur in the glands, 
they should be massaged until softened, and 
the bandage reapplied and worn until the 
secretion ceases. When the weaning can 
more gradually be done, the best way is to 
give one less nursing every second or third 
day until only two are given. After this has 
been practised for one week, these also can 
be discontinued. In cases where sudden 
weaning is required, a saline laxative, such 
as citrate of magnesia or Rochelle salts, 
should be given every day for five days — 
sufficient to produce two or three watery 
evacuations daily. In the meantime the 
mother should abstain from fluids of all kinds 
up to the point of positive discomfort. 

THE SELECTION OF MILK 

The selection of the milk on which the baby 
is to live is a matter of no little importance. 
There is a vast difference in the quality and 
cleanliness of the milks on the market. Too 
many mothers look upon all milk as being of 
uniform value because it all has a similar 
appearance. While the general character of 



54 The Selection of Milk 

the milk sold has improved greatly as regards 
cleanliness during the past few years, a great 
deal of that used at the present time is unfit 
for food for a baby. 

Certified milk. — New York City mothers 
should insist that the milk used be bottled 
and sealed at the farm, and also insist that it 
be certified by the New York Milk Com- 
mission. Milk if properly produced is ex- 
pensive; it cannot be sold for six or eight 
cents a quart, and mothers will have to pay 
more than this if they get a suitable article. 
The most expensive milk will, as a rule, be 
found safest for use. 

Necessary precautions. — When certified 
milk or one of the higher-class milks is not 
obtainable, as is the case with those whose 
home is in the country, and for the families 
from the larger cities who spend the summer 
months in more or less remote country 
districts, the matter of securing a safe milk is 
of vital importance. The average farmer is 
notoriously careless in the handling of milk, 
and in the country districts, where the milk 
supply should be the best, it is often as bad as 
can well be imagined. In the country, where 
the milk is furnished by the farmer direct, a 



The Selection of Milk 55 

special arrangement may be made, by which 
he agrees: that the cow's belly, udder, and 
teats shall be wiped off with a damp cloth 
before milking; that the milker's hands shall 
be washed before milking ; that the few jets of 
the fore-milk shall be thrown away ; and that 
as soon as the milk is drawn it shall be 
strained through absorbent cotton into a 
quart milk bottle, suitably corked, and placed 
in a pail of cracked ice. The cracked ice 
and the absorbent cotton, are, of course, 
furnished by the consumer. For the extra 
trouble the farmer receives from twelve to 
twenty cents a quart for the milk. The 
improved milk-pail with the small top open- 
ing insures a much cleaner milk, as it offers 
much less opportunity for droppings to fall 
into it during the milking. 

For those who have country homes and 
who can control their milk-supply, the above 
precautions may be carried out to the letter. 
By such careful control of the home product, 
and by the use of milk from those dairies 
only which observe the above precautions, 
the acute digestive disorders of summer 
among my patients are rendered a very un- 
usual occurrence. These precautions, with 



56 The Selection of Milk 

the knowledge of the mother or nurse as to 
what to do at the first sign of a digestive 
disorder, will reduce the number of the so- 
called summer diarrhoea cases to a very 
insignificant figure. 

A further and very essential requirement 
is that all cows used for furnishing milk to 
infants be tested for tuberculosis every six 
months. 

Care of the milk a] ter delivery. — There is very 
little gained through the farmer producing a 
clean safe milk and keeping the milk iced until 
delivered if the mother or nurse allows it to 
stand in the hot air of the kitchen and perhaps 
exposed to flies and other insects. As soon 
as received the milk should be placed in the 
ice-box on the ice, not in the compartment 
below, where the vegetables and meats are 
kept. Here the milk should rest until such 
time in the morning as the mother is able to 
devote her attention to the preparation of 
the food. When the family conditions allow 
there should be a special ice-box for the baby's 
milk. 



Pasteurization of Milk 57 

STERILIZATION AND PASTEURIZA- 
TION OF MILK 

Sterilized milk is rarely used at the present 
time in routine feeding. Milk is said to be 
sterilized when it has been heated to the 
boiling point, 212 F., and kept at this point 
for thirty minutes. 

Pasteurized milk is milk heated to 155 F. 
and kept at this temperature for thirty 
minutes. In heating the milk we have two 
objects in view: to kill the harmful micro- 
organisms which it may contain, and to keep 
the milk sweet for a longer time than would 
otherwise be possible. The degree of heat 
to which the milk is subjected should depend 
upon the season of the year, the source of 
the supply, the age of the milk, and the diges- 
tive capacity of the child. The more the 
milk is heated the more difficult of digestion 
it becomes, and the more liable it is to pro- 
duce constipation; so that, other things being 
equal, the less we heat the milk the better 
the nourishment we furnish to the child. In 
country districts where the cows are known 
to be healthy, and the milk clean and fresh, 
heating is unnecessary. In cities and large 



58 



Pasteurization of Milk 



towns, where the source of the milk may be 
unknown, and where it is from twenty-four 
to thirty-six hours old when it reaches the 
consumer, heating to a moderate degree is a 
safe procedure at any time of the year. Pas- 




fig. 4. 



FREEMAN PASTEURIZER WITH BOTTLE RACK 
REMOVED 



teurizing the milk kills most of the dangerous 
germs without materially affecting the diges- 
tibility, or changing the taste of the milk. 
Among the intelligent and cleanly I advise 
the pasteurization of milk; among the igno- 
rant poor and the careless, — such as we fre- 
quently see in out-patient work, — the milk 
should be boiled, particularly during the hot 



The Nursing-Bottle and Nipple 59 

months. The pasteurization of milk is best 
accomplished by the use of the Freeman 
Pasteurizer (see Fig. 4). Directions for use 
are furnished with the Pasteurizer. 

If for any reason the Freeman Pasteurizer 
cannot be used, the milk may be heated in a 
double boiler. If this is not at hand an ordi- 
nary agate basin may be used. The vessel 
should be placed over a slow fire, with a milk 
thermometer held in the mixture. When 
the thermometer registers 170 F., remove the 
milk from the fire and pour it into as many 
bottles as there are feedings in the twenty- 
four hours. Absorbent cotton should be 
used for stoppers. The bottles should be 
cooled rapidly by placing them in cold water. 
The Freeman Pasteurizer should always be 
used if possible, for the reason that it saves 
much trouble, the temperature to which the 
milk is heated is uniform, it requires no mani- 
pulation of the milk after it has been prepared 
and heated, and there are no chances of the 
contamination of the milk from the air. 

THE NURSING-BOTTLE AND NIPPLE 

There are two requirements that a nursing- 
bottle must fulfil: it must have a capacity 



6o The Nursing-Bottle and Nipple 




sufficient for one full feeding, and it must be 
so constructed as to be readily cleansed. 
The oval bottle (Fig. 5) with rounded edges 
answers best. These may be 
obtained in sizes of from three 
to nine ounces. As many bot- 
tles are needed as there are 
feedings in twenty-four hours. 
The bottles should be boiled 
once a day, scrubbed with a 
stiff brush, using hot borax 
water, two teaspoonf uls of 
borax to a pint of water. The 
bottles should then be placed 
in cold boiled water and kept 
there until required. The 

W straight, black nipple (Fig. 5) is 
also preferred, for the reason 
that it can be turned inside 
out and easily cleansed. A nip- 
ple which cannot be turned 
should never be used. After using, a nipple 
should be turned and scrubbed with a stiff 
brush and borax water — a tablespoonful of 
borax to a pint of water. When not in use, 
the nipple should be kept in borax water. 
Before placing it on the bottle it should be 



FIG. 5. NURS- 
ING BOTTLE AND 
NIPPLE 



Artificial Feeding 61 

rinsed in boiled water. The nipples should 
be boiled once a day. The blind nipples — 
those without holes — are the best. Holes of 
the required size may be made with a red- 
hot cambric needle. 

ARTIFICIAL FEEDING 

BOTTLE-FEEDING 

When it is decided that the child will have 
to be nourished by other means than the 
breast, we are obliged to furnish a suitable 
substitute for the mother's milk which the 
child has a right to demand. In our selec- 
tion we must be guided by Nature and fur- 
nish a food that will correspond as closely as 
possible to the mother's milk. This can be 
done only by the use of cows' milk properly 
prepared and diluted. Proprietary foods 
and condensed milk furnish very poor sub- 
stitutes, as will be seen under their respective 
headings elsewhere. Cows' milk differs from 
mother's milk in its most important con- 
stituents. Good cows' milk contains pri- 
marily 3.50 to 4 per cent, of fat, 3.50 to 4 per 
cent, of proteid, and 4 to 5 per cent, of sugar. 



62 Artificial Feeding 

Mother's milk on the other hand contains 
3.5 to 4 per cent, of fat, 1.5 per cent, of pro- 
teid, and 7 per cent, of sugar. It will be seen 
that cows' milk contains more proteid (curd) 
and less sugar than is contained in mother's 
milk. We must endeavor to make the propor- 
tion of the important constituents of cows' 
milk — the fat, proteid, and sugar — correspond 
to that of mother's milk. This has given rise 
to the term modified milk. Cows' milk is 
made to correspond to that of the mother by 
diluting it with water to reduce the proteid, 
and then by adding cream and milk-sugar to 
bring up the fat and sugar to the required 
strength. 

The term modified milk is not a good one, 
for the term "modified" does not cover all 
that is done in rendering cows' milk a suitable 
diet, that is, changing it to correspond to 
mothers' milk. We would have very little 
success in infant feeding if this were all we 
did. The milk must be adapted to a child's 
age and peculiarities, so that the term adapted 
milk expresses far better what we wish to ac- 
complish. In adapting milk to an infant, 
we must remember that cows' -milk proteid 
(curd) is more difficult to digest than the 



Artificial Feeding 63 

proteid of mothers' milk, and that frequently 
a smaller amount of fat must be given than 
is contained in mothers' milk. Particularly 
must these precautions be observed in the 
very young and delicate. The gravest error, 
and one most frequently made in cows'-milk 
feeding, is that of giving the food too strong, 
at the beginning. In consequence, the diges- 
tive organs are overtaxed, the child vomits, 
has colic, suffers from constipation or diarr- 
hoea, and, of course, cannot thrive ; cows' milk 
is therefore discarded because it did not agree 
with the baby, while it was not the milk but 
the way it was given that was at fault. In 
the feeding formulas given below, the milk 
is adapted to the various ages of infancy and 
not to the child's condition, as that would 
obviously be impossible. These formulas 
will be found suitable for average infants in 
fair health. In the matter of feeding, every 
child is a law unto himself and he must be 
fed individually. For some babies the form- 
ulas suggested will not answer at all. One 
six-months' child may require the nine- 
months' formula, while another may be able 
to take only the three-months' formula. All 
babies of the same age or weight must not be 



64 Artificial Feeding 

expected to thrive on food of exactly the 
same strength. 

It is the duty of the physician to adapt the 
milk to the patient's digestive capacity by 
giving to each the required proportion of fat, 
proteids, and sugar. The signs of successful 
bottle-feeding are the same as of successful 
breast-feeding: comfort, sleep, and an aver- 
age gain in weight of not less than four ounces 
a week. There should be two or three yellow 
stools daily. 

Unsuccessful feeding. — The signs of unsuc- 
cessful feeding are vomiting, discomfort after 
feeding, habitual colic, green, undigested 
stools, and loss, or a very slight gain, in 
weight. A very few children cannot take 
cows' milk in any form. In this class belong 
those who have been badly managed. They 
have taken cows' milk too strong or other- 
wise improperly adapted. They may have 
undergone a series of hysterical changes with 
various proprietary meal foods in the hope 
that something might be found which would 
agree with them and on which they might 
thrive. 

In some cases cows' milk of any strength 
produces colic and vomiting or more often 



Food Formulas for Well Babies 65 

diarrhoea. These difficult feeding cases, 
whether the result of the delicate or peculiar 
condition of the child per se or of improper 
feeding, require the greatest patience on the 
part of the physician and mother. Many of 
these cases must be seen by the physician 
every day for weeks before they can be 
brought to take a suitable diet. Milk in 
some must be temporarily discarded and 
substitutes, such as whey, diluted cream, 
barley water, broths, or malt soups, have to 
be used. After a short time a very small 
amount of milk may be added to the substi- 
tute which has been found best to agree. 
Should the milk again cause disturbance, 
condensed milk — one-half to one teaspoon- 
ful — may be given with barley water, in- 
creasing the amount of condensed milk 
gradually if it is found to agree. A wet- 
nurse is almost indispensable in some of 
these cases. 

FOOD FORMULAS FOR WELL BABIES 

In using cow's milk for infant feeding the 
milk is allowed to stand in the quart bottle 
on the ice for five hours. 



66 Food Formulas for Well Babies 



The 
with a 








FIG. 6. 

THE 
CHAPIN 
DIPPER 



top 1 6 ounces are then dipped off 
one ounce cream dipper. (See Fig. 6) . 
If a dipper is not available the top 
16 ounces may be carefully- 
poured out of the bottle. The 
poured off top 16 ounces is the 
milk used until the third month; 
after this age larger amounts must 
be poured or dipped from the top. 
The following formulas are sug- 
gested for the various ages noted: 

FROM THE THIRD TO THE TENTH DAY 

Milk (top 16 oz.) 3 ounces 

Lime-water yi ounce 

Milk-sugar I ounce 

Boiled water i6>£ ounces 



Seven feedings in twenty-four hours; 2 to 3 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 



FROM THE TENTH TO THE TWENTY-FIRST DAY 

Milk (top 16 oz.) 6 ounces 

Lime-water \yi ounces 

Milk-sugar i}4 ounces 

Boiled water 16^ ounces 



Food Formulas for Well Babies 67 

Seven feedings in twenty-four hours; 2 to 3 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 

FROM THE THIRD TO THE SIXTH WEEK 

Milk (top 16 oz.) 10 ounces 

Lime-water 2 ounces 

Milk-sugar 2 ounces 

Boiled water 20 ounces 

Seven feedings in twenty-four hours; 3 to 4 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 

FROM THE SIXTH WEEK TO THE THIRD MONTH 

Milk (top 16 oz.) 14 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Boiled water 18 ounces 

Seven feedings in twenty-four hours; 4 to 5 
ounces at three-hour intervals during the day 
and four-hour intervals at night. 

FROM THE THIRD TO THE FIFTH MONTH 

Milk (top 18 oz.) 18 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Boiled water 19 ounces 



68 Food Formulas for Well Babies 

Six feedings in twenty-four hours; 5 to 6 
ounces at three-hour intervals during the day 
and a feeding at 10 p.m. 

FROM THE FIFTH TO THE SEVENTH MONTH 

Milk (top 24 oz.) 24 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Boiled water 15 ounces 

Five feedings in twenty-four hours; 6 to 7 
ounces at four-hour intervals, the last feeding at 

10 P.M. 

FROM THE SEVENTH TO THE NINTH MONTH 

Milk (whole) 28 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Barley water 14 ounces 

Five feedings in twenty-four hours; 7 to 9 
ounces at four-hour intervals, the last feeding 
at 10 p.m. 

FROM THE NINTH TO THE TWELFTH MONTH 

Milk (whole) 32 ounces 

Lime-water 3 ounces 

Milk-sugar 2 ounces 

Barley water 10 ounces 



Food Formulas for Well Babies 69 

Five feedings in twenty-four hours; 8 to 9 
ounces at four-hour intervals, the last feeding 
at 10 p.m. 

Whole milk. — To obtain whole milk shake 
the bottle before use. 

Barley water. — Barley water is made by 
cooking 1 ounce of Robinson's or Cereo bar- 
ley flour in the called-for water for thirty 
minutes. Boiled water is added to replace 
the amount lost in boiling. The barley water 
should not be hot when added to the milk 
and lime-water. Milk-sugar may be dis- 
solved in hot barley water. 

Keep the nursing bottles on the ice after they 
are filled. 

Convenient feeding hours are 6, 10, 2, 
6, 10 p.m. after 5 months of age. Strong 
vigorous infants may require stronger food 
than the above after the tenth month. 

Farina and cream of wheat. — It is not at all 
unusual for me to allow such infants a table- 
spoonful or two of farina or cream of wheat 
jelly (cooked two hours in water) before the 
10 a.m. and 6 p.m. feedings, with an ounce or 
two of the milk formula over it. 

Beef juice and dried bread. — Occasionally at 
this age, 2 or 3 teaspoonfuls of beef-juice 



70 Food Formulas for Well Babies 

mixed with bread-crumbs are given before 
the 2 P.M. feeding. A piece of unsweetened 
zwieback or a crust of dried bread may- 
be given after the bottle. 

It will be noticed that considerable latitude 
is allowed as to the amount of food which is 
to be given at one feeding. This is because 
of the difference in the capacity of individual 
children. After the third month the mid- 
night feeding should be discontinued. Six 
feedings will be sufficient, the first at 6 A.M. 
and the last at io p.m. Between io p.m. and 
6 a.m. the child should sleep. Babies are 
easily broken from the night bottle by sub- 
stituting a bottle of boiled water or a milk 
mixture greatly diluted with water. The 
child soon discovers that this is not worth 
waking for. As a result of a full night's rest 
the digestive organs are better able to do 
their work, the appetite is increased, and a 
larger amount of food may be given at each 
feeding. 

Special adaptation. — The foregoing formu- 
las will be found useful for the majority of 
average well babies. Those with pronounced 
digestive peculiarities should have the food 
especially adapted. 



Feeding after the First Year 71 

When the milk does not agree the cause 
must be discovered. The food as a whole 
may be too strong, when there will be indi- 
gestion and colic, and possibly diarrhoea and 
vomiting. If the food contains too much 
cream there will be looseness of the bowels, 
and colicky stools, with considerable strain- 
ing; there is apt to be regurgitation also. 
An indication of excess of sugar consists in 
the eructation of gas and a regurgitation of 
sour, watery material. Diarrhoea may also 
be produced by too high sugar. Excess of 
cows' -milk proteid may be the cause of 
habitual colic, and is an important element 
in habitual constipation. We sometimes see 
children who cannot take fresh cows' milk 
in any form. In these the milk must be 
cooked or one of the evaporated milks given. 

FEEDING AFTER THE FIRST YEAR 

At the completion of the twelfth month 
the average well-regulated baby should be 
weaned, and other nourishment given. If 
bottle-fed, he should receive more than the 
milk and cereals, with which most children 
are fed. The food suitable for the second 



72 Feeding after the First Year 

year of life and the method of its prepara- 
tion and administration are subjects upon 
which the masses are most profoundly igno- 
rant. A few children at this period of life 
are overfed, and carelessly given, at improper 
intervals, unsuitable food, wretchedly cooked. 
Summer diarrhoea finds its greatest number 
of victims among those children over twelve 
months of age who have been carelessly 
fed. The dreaded "second summer" robs 
many homes because of ignorant or careless 
parents. The second summer managed prop- 
erly is hardly more dangerous than any other 
summer during the early years of a child's 
life. It is almost a universal custom when 
the child is weaned or given something other 
than a milk diet to allow him "tastes" from 
the table. Very often these tastes comprise 
the entire dietary of the adult. Milk is 
oftentimes the only suitable article of diet 
that is given. Afterward not only is the 
other food selected unsuitable, but it is given 
irregularly, and supplemented by crackers 
kept on hand for use between meals. During 
the hot months the gastro-intestinal tract is 
less able to bear such abuse and the child 
becomes ill. Usually when the twelfth 



Feeding after the First Year 73 

month is completed I give the mother a diet 
schedule, with instructions to begin gradually 
with the articles allowed, in order to test the 
child's ability to digest them. Every new 
article of food should be carefully prepared 
and given at first in very small quantities. 
All meals are to be given regularly, with 
nothing between meals. With many children 
this expansion of the diet list is attended with 
considerable difficulty. They are thoroughly 
satisfied with the milk, and refuse all other 
forms of nourishment. In such cases time 
and patience are necessary at the feeding 
time. The more solid articles of diet should 
be given first, and the milk kept in the 
background. 

Among the underfed seen at this period of 
life are those who were nursed too long or 
those who were kept for too long a time upon 
an exclusive milk diet. A great majority of 
the cases of malnutrition of the second year 
are seen in the exclusively milk-fed. They 
are pale, soft, flabby, badly nourished children. 

The following is a diet schedule which 
I have employed for several years. Each 
mother is instructed to select, from the foods 
allowed, a suitable meal. 



74 Feeding after the First Year 

From the twelfth to the fifteenth month: five 
meals daily, 

7 a.m. Oatmeal, barley, or wheat jelly, 
one to two tablespoonfuls, in eight ounces 
of milk. (The jelly is made by cooking the 
cereal for three hours the day before it is 
wanted and straining through a colander.) 
Stale bread and butter or zwieback and 
butter. 

9 a.m. The juice of an orange. 

ii a.m. Scraped rare beef, one to three 
teaspoonfuls mixed with an equal quantity 
of bread-crumbs and moistened with beef- 
juice, or a soft-boiled egg mixed with stale 
bread-crumbs; a piece of zwieback, and a 
half -pint of milk. 

(Scraped beef is best obtained from round 
steak, cut thick and broiled over a brisk fire 
sufficiently to sear the outside. The steak 
is then split with a sharp knife and the pulp 
scraped from the fibre.) 

3 p.m. Beef, chicken, or mutton broth 
with rice or stale bread broken into the broth. 
Six ounces of milk, if wanted. Stale bread 
and butter or zwieback and butter. Many 
children at the above age will take and digest 



Feeding after the First Year 75 

apple sauce and prune pulp; when these are 
given milk should be omitted. 

6 p.m. Two tablespoonfuls of cereal jelly- 
in eight ounces of milk; a piece of zwieback. 
Stale bread and butter or Huntley and 
Palmer breakfast biscuit. 

10 p.m. A tablespoonful of cereal jelly in 
eight ounces of milk. 

From the fifteenth to the eighteenth month: 
four meals daily. 

7 a.m. Oatmeal, hominy, cornmeal, each 
cooked three hours the day before they are 
used. When the cooking is completed the 
cereal should be of the consistency of a thin 
paste. This is strained through a colander. 
When cool it will form a mass of jelly-like 
consistency. Of this give two or three table- 
spoonfuls served with milk and sugar or 
butter and sugar or butter and salt. Eight 
to ten ounces of milk as a drink. Zwieback 
or toast or Bennett's wheat sworth biscuit. 

9 a.m. The juice of one orange. 

11 A.M. A soft-boiled egg mixed with 
stale bread-crumbs, or one tablespoonful of 
scraped beef mixed with stale bread-crumbs 



76 Feeding after the First Year 

and moistened with beef -juice. A drink of 
milk. Zwieback or bran biscuit, or stale 
bread and butter. 

3 p.m. Mutton, chicken, or beef broth 
with rice or with stale bread broken in the 
broth. Custard, cornstarch, plain rice pud- 
ding, junket, stewed prunes, baked apple, 
or apple sauce. 

6 p.m. Farina, cream of wheat, wheat ena 
(each cooked two hours). Give from one to 
three tablespoonfuls served with milk and 
sugar or butter and sugar or salt and butter. 
Drink of milk. Zwieback or stale bread and 
butter. 

From the eighteenth to the twentieth month: 
four meals daily. 

7 a.m. Cornmeal, oatmeal, hominy (pre- 
pared as in the above schedule). Serve 
with butter and sugar or milk and sugar or 
butter and salt. A soft-boiled egg every 
two or three days. Minced chicken on toast 
occasionally. A drink of milk. Bran bis- 
cuit and butter, or stale bread and butter, or 
wheatsworth biscuit. 

9 a.m. The juice of one orange. 



Feeding after the First Year 77 

11 a.m. Rare beef, minced or scraped, 
the heart of a lamb chop, finely cut. Minced 
chicken. Spinach, asparagus tips, squash, 
strained stewed tomatoes, stewed carrots, 
mashed cauliflower. Baked apple or apple 
sauce. Stale bread and butter. 

After the twentieth month, baked potato 
and well-cooked string beans may be given. 

2.30 p.m. Chicken, beef, or mutton broth 
with rice or with stale bread broken into 
the broth. Custard, cornstarch, or plain rice 
pudding, junket, stewed prunes. Bran bis- 
cuit and butter or stale bread and butter. 

6 p.m. Farina, cream of wheat, wheatena 
(each cooked two hours). Give from one to 
three tablespoonfuls served with milk and 
sugar or butter and sugar or salt and butter. 
Drink of milk. Zwieback or stale bread and 
butter. 

From the second to the third year: three meals 
daily. 

Breakfast (7 to 8 o'clock). — Oatmeal, 
hominy, cracked wheat (each cooked three 
hours the day before they are used), served 
with milk and sugar or butter and sugar. 



78 Feeding after the First Year 

A soft-boiled egg, hashed chicken. Stale 
bread and butter. Bran biscuit and butter. 
A drink of milk. 

At ten o'clock the juice of one orange may- 
be given. 

Dinner (12 o'clock). — Strained soups, and 
broths, rare beefsteak, rare roast beef, poul- 
try, fish. Baked potato, peas, string beans, 
mashed cauliflower, mashed peas, strained 
stewed tomatoes, stewed carrots, spinach, 
asparagus tips. Bread and butter. A glass 
of milk. For dessert: plain rice pudding, 
plain bread pudding, stewed prunes, baked 
or stewed apple, junket, custard, or corn- 
starch. 

Supper (5.30 to 6 o'clock). — Farina, cream 
of wheat, wheatena (each cooked two hours). 
Give from one to three tablespoonfuls served 
with milk and sugar or butter and sugar or 
butter and salt. Drink of milk. Zwieback 
or stale bread and butter or wheatsworth 
biscuit. Twice a week, custard or cornstarch 
or junket may be given, or a tablespoonful 
of plain vanilla ice-cream. 

As a rule, three meals answer best at this 
period. With three meals a child has better 
appetite and much better digestion, and 



Feeding after the First Year 79 

consequently thrives far better than one 
whose stomach is kept constantly at work. 
Some children, however, will require a lunch- 
eon at 3 or 3.30 p.m., and will not do well 
without it. This is apt to be the case with 
delicate children, particularly those under 
two and one-half years of age. If food is 
necessary at this hour, a glass of milk and a 
graham biscuit, or a cup of broth and zwie- 
back will answer every purpose. Instead of 
the afternoon meal, the child may relish a 
scraped raw apple or a pear. The fruit at 
this time is particularly to be advised if there 
is constipation. Children recovering from 
serious illness will require more frequent 
feeding. 

From the third to the sixth year. 

Breakfast. — Cracked wheat, cornmeal, hom- 
iny, oatmeal (each cooked three hours the 
day before they are used). These may be 
served with milk and sugar or butter and 
sugar or butter and salt. A soft-boiled egg, 
omelet, scrambled egg, chop. Bread and 
butter, bran biscuit and butter or wheats- 
worth biscuit. A glass of milk. 



80 Feeding after the First Year 

Dinner. — Plain soups, rare roast beef, 
beefsteak, poultry, fish. Potatoes boiled 
in milk, or baked. Peas, string beans, 
strained stewed tomatoes, stewed carrots, 
squash, boiled onions, mashed cauliflower, 
spinach, asparagus tips; bread and butter. 
For dessert: Rice pudding, plain bread pud- 
ding, custard, tapioca pudding, stewed prunes, 
stewed apples, baked apples, raw apples, 
pears, and cherries. 

Supper. — Farina, cream of wheat, wheat- 
ena (each cooked two hours). Give from 
two to three tablespoonfuls served with milk 
and sugar or butter and sugar or salt and 
butter. Zwieback or stale bread and butter. 
Bread and milk. Milk toast. Scrambled 
egg twice a week. Custard or cornstarch 
each once a week; ice-cream once a week; 
bread and butter. A glass of milk. 

When the child has eggs for breakfast, 
they should not be repeated in any form for 
supper. Red meat should be given but once 
a day. When the child has a chop for break- 
fast, he should have poultry or fish for dinner. 
At this age of great activity and rapid growth, 
the child will often demand food between 
dinner and supper. Carefully selected fruit, 



Diet after the Sixth Year 81 

such as an apple, a pear, or a peach, may be 
given at this time, supplemented by a gra- 
ham cracker or two, or by stale bread and 
butter, if it is found that their use does not 
interfere with the evening meal. 

DIET AFTER THE SIXTH YEAR 

When the normal child has passed the 
sixth year the diet may be considerably ex- 
panded, approximating to that of the adult 
in variety: certain restrictions, however, are 
to be borne in mind. Fried foods should not 
be given ; highly seasoned dishes, such as pie, 
rich puddings, gravies, and sauces, are to be 
avoided. Salads with plain dressing may 
now be given. Wine and beer, coffee and 
tea, should never be given to children as a 
beverage. A point to be kept in mind in 
feeding children at this age, as well as those 
who are younger, is the proper cooking of 
vegetables. Everything in the line of green 
vegetables should be cooked until it can 
readily be mashed with a fork. 

HOW THE CHILD SHOULD BE FED 

In the foregoing articles on feeding the 
author has endeavored to suggest the na- 

6 



82 How the Child Should be Fed 

ture of the food required by the growing 
child, and the intervals at which food should 
be given. This, however, does not entirely 
cover the subject. A child should never 
dine with adults until he can have adult diet, 
if the circumstances of the family will permit 
him to dine alone or with other children. It 
is a species of cruelty to expect a hungry 
child of tender age to sit at the table, see and 
smell the fragrant dishes, and be forced to 
content himself without complaint with his 
restricted fare. The author recalls this cus- 
tom as a cause of many tears, disputes, 
and fistic encounters with attendants, which 
formed no small part of the daily routine of 
his early life. 

In feeding, the spoon or fork must come 
in contact only with the food and the child's 
mouth; when not in use it should be allowed 
to rest on the clean table-cloth. If it falls to 
the floor by accident it should be dipped 
in boiling water before using it. Under no 
circumstances should a feeding utensil be 
allowed to come in contact with the lips of 
the nurse or mother; time and again I have 
seen mothers and nurses sip or swallow the 
first teaspoonful of the food which is to be 



How the Child Should be Fed 83 

given, to determine if it is of the proper tem- 
perature. At other times, when the food is 
not particularly attractive to the child, they 
will place the spoon in their mouths as though 
they intended to take it themselves. Others 
will remove from the spoon with their own 
lips adhering particles of food. 

There are few more reprehensible prac- 
tices than the foregoing, and if parents knew 
the dangers to which their children are thus 
subjected they would not for one instant 
tolerate them. Any one of the many forms 
of pathogenic bacteria may be most readily 
transferred to the mouth of the child in this 
way. It is unquestionably a means of infec- 
tion with tuberculosis, diphtheria, and syph- 
ilis. The germs of tuberculosis and diph- 
theria are frequently found in the mouths 
of perfectly healthy adults. They cause no 
symptoms of disease because of the normal 
power of resistance of such adults. The 
resisting powers of the child, however, to 
these micro-organisms are very slight, and 
when they are carried to the delicate mucous 
membrane of the infant's mouth and throat 
they thrive actively, the child develops 
diphtheria or tuberculosis, and the family 



84 Condensed Milk (Sweetened) 

grieve and wonder how the child could ever 
have contracted the disease. 

CONDENSED MILK (SWEETENED) 

Canned condensed milk, sweetened, should 
never be selected as a food for a baby if the 
mother can afford to buy cows' milk and can 
learn how to prepare and care for it. The 
child's natural food is the mother's milk; 
this is what he has a right to demand. If 
mothers' milk cannot be furnished we must 
give a substitute which will provide the baby 
with the nourishment contained in mothers' 
milk. Analyses by many chemists of thou- 
sands of samples of good mothers' milk show 
that it contains approximately 3.5 per cent. 
to 4 per cent, of fat, 1.5 per cent of proteid, 
and 7 per cent, of sugar. Condensed milk, 
diluted one to twelve, i.e., one part con- 
densed milk to twelve parts of water, — the 
strength taken by a three-months-old child, 
— will give a food containing .5 per cent, of 
fat and .6 per cent, of proteid, and 4 per cent, 
of sugar. Compare these figures with the 
amount of fat, sugar, and proteid contained 
in mothers' milk and it will readily be seen 



Condensed Milk (Sweetened) 85 

that the baby is not getting nearly as much 
nourishment as Nature would furnish him. 
If the mixture, using the condensed milk, is 
made in the proportion of one part condensed 
milk to eight parts of water — the proper 
strength for a six-months-old child — there 
will still be less than 1 % of fat, and a lower 
proteid than in mothers' milk. Condensed 
milk has its uses, however. Many mothers 
cannot afford to buy fresh cows' milk. Some 
have no refrigerator or ice-box in which to 
keep it. Condensed milk, on account of the 
cane sugar which has been added to it, will 
remain fresh for two or three days after it has 
been opened. It is a most inexpensive means 
of feeding the baby. Further, its prepara- 
tion is exceedingly simple, and many mothers 
are too ignorant to appreciate the importance 
of the careful preparation of cows' milk. 

Condensed milk is for many an absolute 
necessity; but though children manage to 
live on it, they never thrive satisfactorily. 
They all show evidence of some degree of 
rickets, unless fat in some form, e.g., cod- 
liver oil or cream, is given in addition, to 
supplement the food: and very few children 
can take cod-liver oil during the summer 



86 Condensed Milk (Sweetened) 

months. There is another class of children 
for whom condensed milk has served us well 
at various times. They are the young, deli- 
cate infants, with very weak digestive powers. 
Their mothers cannot nurse them, wet-nurses 
are impossible, and, for some reason, the 
smallest amount of cows' milk, most care- 
fully adapted, cannot be tolerated; a single 
teaspoonful of milk or cream in two ounces 
of plain water, whey, weak milk-sugar water, 
or barley water produces colic and diarrhoea. 
I have successfully fed several of these infants 
on a mixture consisting of one part of con- 
densed milk and twelve parts of water. I 
prefer the unsweetened variety. For some 
unexplained reason these children digest the 
condensed milk without any inconvenience 
and do fairly well for a few weeks, when the 
secretion of the digestive juices will be better 
established and a weak adapted cows' -milk 
mixture will be borne. Condensed milk is 
also useful in travelling. During journeys 
by land and sea, condensed milk with boiled 
water will furnish satisfactory food for a 
limited time at a minimum amount of 
trouble. 

The following formulae may be found of 



Condensed Milk (Sweetened) 87 

service to those who for any reason are forced 
to use a temporary substitute for adapted 
cows' milk : 

First month of life: 1 part of condensed milk 
to 16 of water. 

Second month: 1 part of condensed milk to 
14 of water. 

Third month: 1 part of condensed milk to 12 
of water. 

Fourth to sixth month : 1 part of condensed 
milk to 10 of water. 

After the sixth month: 1 part of condensed 
milk to from 8 to 10 of water. 

Condensed milk, unsweetened: In the un- 
sweetened condensed milk known on the 
market as evaporated milk, we have a very 
helpful means in the feeding of many delicate 
infants. Through the processes of evapora- 
tion the milk is made easier of assimilation 
by the child. It is used after the fashion of 
fresh cow's milk through the addition of 
water, sugar, barley, lime-water, etc. One 
ounce represents 2-J ounces of fresh cow's 
milk. This concentration has to be con- 
sidered in arranging the formula. 



88 The Proprietary Foods 
THE PROPRIETARY FOODS 

The foods on the market prepared for 
purposes of infant feeding are almost with- 
out number. From our knowledge of the 
composition of mothers' milk we learn what 
nutritional elements and approximately in 
what relative proportions these elements 
must exist in order to supply the child with 
the food which Nature intended him to have. 
The examination of the milk of thousands 
of nursing women shows that it ranges from 
2.5 to 4 per cent, fat, 6 to 7 per cent, sugar, 
and 1 to 1.5 per cent, proteid. These figures 
may be put down as the normal limits of 
human milk, and they are so, simply because 
the infant will thrive and grow when the 
nutritional elements in approximately the 
above proportions are supplied to him. It 
is within these limits that the food must 
be kept in order that there may be normal 
growth and development; though of course, 
wide variations from these may be of tem- 
porary occurrence. While the child may 
exist and temporarily do fairly well on a 
percentage of fat lower than 2.5, he will in- 
variably show defective growth if the proteid 



The Proprietary Foods 89 

remains persistently under 1 per cent. The 
chief disadvantage in the infant foods which 
are used without the addition of cows* milk, 
lies in the fact that they do not contain the 
nutritional elements as they exist in normal 
breast-milk, and besides, of necessity, they 
are all cooked foods. 

In selecting a substitute for mothers' milk 
one point is to be kept in mind, viz., the 
substitute should contain, in a readily assimi- 
lable form, the nutritional elements in approxi- 
mately the proportions and forms in which 
they exist in mothers' milk. All other feeding 
is defective. It is not well to put too much 
reliance on the analysis sometimes published 
by the proprietary food manufacturer. This 
type of food is decidedly weak in animal fat, 
for the reason that there is no means of keep- 
ing more than a small percentage of it in 
a food without its becoming rancid. When 
considerable percentages are indicated in the 
analysis it is certain that it does not consist 
of butter fat. The quantity of animal milk 
proteid is likewise deficient. Scurvy is not 
an infrequent result of the exclusive use of 
these foods. 

The uses of proprietary dried-milk foods. 



90 The Proprietary Foods 

— It is to be remembered that this type of 
food is condemned because of its being an 
unsuitable food when used exclusively and 
persistently. In constipation in ' ' runabout " 
and older children who are on a general diet, 
the importance of milk in the nutrition is a 
secondary one, and is often an important 
factor in the production of constipation. 
In these cases cows' milk may be replaced 
by one of the proprietary dried-milk foods 
which has a laxative effect, with a good deal 
of advantage. I sometimes employ them 
further in other disordered states. During 
acute illness and in convalescence from ill- 
ness and in certain forms of malnutrition 
they are usually readily digested and may 
help us over difficult places. 

Proprietary foods to which fresh cows' milk 
is added. — These are not foods in the usual 
acceptation of the term, and if they are 
used alone independent of milk the patient 
will soon present a sorry spectacle. They are 
sugars largely, being composed of maltose 
and dextrin, which are derived from starch. 
Some contain a considerable quantity of 
unconverted starch. When added to the 
water and milk mixtures they furnish the 



The Proprietary Foods 91 

soluble carbohydrates in the form of maltose 
and free starch, and thus fulfil this function 
in the food with as good results as, but usually 
no better than, would milk-sugar and a ce- 
real gruel. Maltose is a laxative sugar. In 
case of constipation in the bottle-fed it may 
replace the milk-sugar in equal quantity, 
and as such may be used with decided advan- 
tage in some cases. In others, this change 
to maltose is without effect. The claim that 
when added to cows' milk these proprietary 
foods increase the liability to scurvy is 
without foundation. If the milk is given 
uncooked, the child will not have scurvy, 
regardless of the nature of the sugar; if the 
milk is heated to 160 or 170 F., the child 
may have scurvy regardless of the sugar. 

According to my observation, the state- 
ment that the addition of maltose to cows' 
milk facilitates its digestion is unfounded. 
I have tried it in many cases, but have never 
been able in consequence to use a stronger 
cows' -milk mixture. The true test of such 
a measure is its use in the delicate and in 
difficult feeding cases, and not in well babies 
who thrive regardless of the sugar employed. 
The maltose preparations, then, in the sense 



92 The Proprietary Foods 

that they may contain a small amount of 
proteid and a laxative sugar, are useful and 
to be recommended when such a carbohy- 
drate is needed. 

The proprietary beef foods. — Numerous 
preparations of this nature are on the market 
and there has been abundant opportunity 
to test their value. Without going into a 
lengthy discussion as to how and under what 
conditions these preparations have been used, 
it is sufficient to say that as a means of nutri- 
tion in children they play a very unimportant 
part. Their principal use is in illness, in 
which they act as a stimulant, and to a less 
degree as a food. They all make weak pro- 
teid mixtures when diluted so that the child 
can take them. The possibility of supplying 
any great amount of nutrition to the economy 
by their use is small; occasionally, however, 
they may be used to advantage. When milk 
is withdrawn they may be added to the cereal 
gruel substitute. If there is diarrhoea, great 
care must be exercised, as the proprietary 
beef preparations as well as beef-juice may 
increase it. On account of the creatinin 
which they contain, they should not be given 
in any of the forms of nephritis. Another 






Milk for Travelling 93 

feature which limits their use is that a child 
soon tires of them. They can rarely be given 
more than two or three times in twenty-four 
hours. Valentine's is the preparation I usu- 
ally select. It may be given in solution — 
one-quarter to one-half teaspoonful to six 
ounces of the diluent. 

MILK FOR TRAVELLING 

In making long journeys with infants by 
land or water, the feeding of the child is an 
important matter, and advice is often sought 
by mothers who wish to make the contem- 
plated trip with the least possible risk. It 
is, of course, desirable that no change be 
made in the milk commonly used, and there 
are means of treating the milk and of keeping 
it which enable us to assure the patient of 
reasonable safety. It is my custom with 
city children to have the milk prepared at 
the Walker-Gordon Laboratory, where at a 
trifling expense small ice-boxes can be ob- 
tained which contain sufficient space for a 
few days' supply of milk and which can be 
conveniently carried on cars and boats. They 
have also larger boxes with a capacity of 



94 Milk for Travelling 

twelve quarts, which may be used for an 
ocean voyage. The smaller box will need 
refilling with ice once or twice a day, which 
is usually readily secured. The larger box, 
for ocean voyages, is packed in ice and placed 
in a cold-storage room of the vessel and will 
not need repacking during the trip. Labo- 
ratory milk, however, is available for com- 
paratively few. 

Milk prepared at home for a journey should 
be cooled to 45 F. as soon as it is drawn, and 
kept at this temperature until it can be ster- 
ilized at a temperature of 212 F. for twenty 
minutes. It then should be cooled rapidly 
to at least 50 F. and kept at this point until 
used. These directions can be carried out 
by any intelligent f amity. When this is done 
the milk will be safe for use for the time re- 
quired — from seven to eight days. Even the 
suggestions as to the making of an ice-box 
can be followed in any town or village. All 
that is required is the ice-box, one-quart 
fruit jars or one-quart milk bottles, and clean 
milk. Those who for any reason cannot 
avail themselves of the milk thus preserved 
will find in canned condensed milk a fairly 
good substitute. If kept on ice and wrapped 



Diet during Illness 95 

in a clean towel, a can of condensed milk may 
safely be used for three days after opening. 
Formulas suited for the various months of 
infancy will be found in the section on con- 
densed milk (page 87). 

DIET DURING ILLNESS 

The digestive capacity of every child is 
diminished during illness, depending largely 
upon the age of the child and the severity 
of the disease. The younger the child, the 
greater the incapacity. This is fairly con- 
stant with all the ailments of childhood, 
including, of course, those which directly 
affect the gastro-enteric tract. In a mod- 
erately severe bronchitis, with a degree or 
two of fever, the digestive capacity is slightly 
diminished and a 25 per cent, reduction in 
the strength of the food will answer. During 
the critical stage of a lobar pneumonia the 
digestive powers are held in abeyance and 
predigested foods and alcohol must sustain 
the patient. During an attack of measles, 
scarlet fever, broncho-pneumonia, or diph- 
theria in bottle-fed infants, at the height of 
the disease, it is my custom to reduce the 



96 Diet during Illness 

strength of the food one-half by the addition 
of water, to make up for the quantity re- 
moved. For ailments of lesser severity, 
such as bronchitis, with a temperature of 
ioo° to ioi° F., or chicken-pox, or mild 
measles, I reduce the strength of the food 
from one-fourth to one-third. In any mild 
ailment or injury which confines a child to 
its bed, the food strength should be cut down, 
for inactivity as well as disease lessens the 
digestive capacity. 

Among nurslings and the bottle-fed these 
precautions are particularly necessary. A 
child with fever is apt to be thirsty and to 
take more food than in health. This is fre- 
quently the case in summer diarrhoea. In 
order to avoid this taking of too much food, 
I not only order the milk to be diluted for 
the bottle-fed, but I instruct the mothers of 
nurslings to give a drink of water immediately 
before each nursing and between nursings, 
and then to allow the child to nurse only one- 
half or two-thirds the usual time. For 
the bottle-fed, one-half to two-thirds of the 
contents of each bottle is removed and the 
quantity replaced by boiled water, so that 
the amount of fluid given remains the same. 



Diet during Illness 97 

If the child is a "runabout," over two 
years of age, he is given broths and thin gruel 
— one-half milk and one-half gruel. By 
carefully watching the stools, thus fitting 
the food to the child's capacity, we will avoid 
grave intestinal complications which, during 
the summer, often prove to be more serious 
than the original ailment. In the acute 
gastro-enteric troubles, and in typhoid fever, 
all milk must be discontinued. 

The art of feeding in illness. — Not only is 
food oftentimes taken in insufficient quantity 
in illness, but in many cases it is absolutely 
refused. In other cases, during coma and 
asthenic states, swallowing is impossible. 
In delirium and in conditions of collapse 
nourishment must be given, and when this 
is impossible by the natural method, we 
have, as temporary substitutes, gavage, oil 
inunctions, and rectal feeding — all referred 
to elsewhere. 

Forced feeding. — Forcing the child to take 
nourishment by the mouth is rarely necessary. 
Coaxing and bribing ordinarily succeed far 
better. For a child from three to five years 
of age a bright new penny possesses much 
persuasive power. The child will usually 



98 Diet during Illness 

take its food better from those to whom it is 
accustomed, like the mother or nursery-maid. 
The trained nurse should understand that 
while unacquainted with the patient, the 
simpler requirements of the child are to be 
looked after by others to whom the patient 
is accustomed. The nourishment should be 
as palatable as possible and served in bowls, 
cups, or plates that are attractive to the 
patient because of color, pictures, or pecu- 
liarities of shape. Junket, flavored with 
vanilla, served cold is a favorite food for 
sick children of the "runabout " age. Frozen 
custard, and home-made ice-cream, made 
with one-third cream and two-thirds milk, 
will usually be well taken. Toast, dry bread, 
and crackers made in peculiar shapes are 
attractive to the child. In not a few cases 
I have succeeded in feeding satisfactorily 
children two or three years old, when several 
other schemes had failed, by allowing the 
temporary return to the bottle, from which 
they had been weaned for a year or so. 

In these difficult feeding cases the child's 
peculiarities and wishes must be studied. 
Children in illness require water. Often- 
times they will take it in insufficient quan- 



Vomiting 99 

tities. Those who refuse plain water will 
often take ginger ale, sarsaparilla, or vichy. 
In the event of these drinks being well taken, 
they may be given freely. In the acute in- 
fectious diseases, which include pneumonia, 
free water-drinking is a therapeutic measure 
of no mean value. 

VOMITING 

A sudden attack of vomiting, with fever, 
may usher in any serious illness. Thus, it 
may be the initial symptom of pneumonia, 
scarlet fever, or meningitis. By far the most 
usual cause, however, will be found inti- 
mately connected with the stomach, usually 
an acute attack of indigestion. Bottle-fed 
children furnish the greatest number of pa- 
tients, as these children are often overfed. 

Management. — With the onset of a sharp 
attack of vomiting, particularly if it occurs 
during hot weather, the milk diet should 
immediately be discontinued. Small quanti- 
ties of boiled water, one-half to two ounces 
of barley water, or rice water, or plain broths 
may be given every hour or two. In the 
obstinate cases, quite a period of rest should 



ioo Habitual Vomiting 

be given the stomach. From twenty-four 
to thirty-six hours will often be necessary 
before the child will be able to retain even a 
teaspoonful of water. No milk should be 
given until the vomiting has ceased for at 
least two days. When the milk is resumed 
it should be diluted five or six times with 
water and at first only a small quantity of 
the mixture given. In many of these cases a 
stomach washing will speedily correct the 
trouble. If the stomach bears the food well 
its strength may gradually be increased by 
an additional half-ounce or ounce of milk to 
each feeding daily, until the former diet is 
resumed. 

HABITUAL VOMITING 

Many infants regurgitate or vomit a por- 
tion of every feeding. This means one thing 
always — the child has been or is overfed. 
He is given the food too strong, too much 
sugar or fat, or the amount is greater than 
his capacity, or he is fed at too frequent 
intervals. In either case the stomach relieves 
itself. Many of these children who regurgi- 
tate after each feeding thrive finely in spite 



Malnutrition and Marasmus 101 

of the loss. Enough is retained for their 
nourishment, and they gradually become 
accustomed to the strong food and no serious 
harm results. Such a stomach, however, 
is liable to behave very badly during hot 
weather. During any illness, in fact, which 
taxes the patient's strength, the disordered 
stomach stands ready to furnish an un- 
pleasant complication. 

Management. — The treatment of habitual 
vomiting in the bottle-fed is by a suitable 
adaptation of the food, usually by cutting 
down the fat and sugar and by stomach 
washing. Among the breast-fed the breast- 
milk will have to be examined and, if found 
unsuitable, corrected if possible. If too 
frequent nursings or night nursings have 
been allowed they should be discontinued. 

MALNUTRITION AND MARASMUS 

By malnutrition we understand that con- 
dition in which a child for some reason fails 
to gain in weight or loses steadily for a con- 
siderable period of time. Cases present all 
degrees of severity, from those in which there 
is merely a temporary loss of weight, to those 



102 Malnutrition and Marasmus 

of an extreme degree of malnutrition, which 
latter condition we term marasmus. A ma- 
rasmatic infant presents one of the most 
pitiful pictures we are called to look upon: 
the dry skin drawn tightly over the fleshless 
bones, the sunken eye, the distended abdo- 
men, the anxious, tired expression, and the 
whining cry furnish a picture of starvation 
so pathetic that only those hardened by long 
familiarity with such cases can look upon 
them unmoved. 

Causes of marasmus. — When the history 
of such infants has been looked into it will be 
learned that errors in feeding contributed 
largely to bringing them to their woeful 
condition. Many of these children came 
into the world strong and vigorous, the 
mothers were unable to nurse them, and the 
food selected did not agree with them. 
Cows' milk, perhaps, was given, unsuitably 
adapted, — it usually is given too strong to 
young infants, — at any rate it disagreed, and 
the proprietary meal foods were brought into 
use, one after another, as they were suggested 
by well-meaning friends, each to do its share 
of damage and in turn to be discarded. The 
stomach bore the ill-usage for a time, but 



Malnutrition and Marasmus 103 

soon became so disturbed that the digestion 
of rational food was out of the question. 
Many of these children finally reach the point 
where predigested foods fail to be assimi- 
lated; such cases, of course, are hopeless. 

Lay advice. — It is a source of amusement 
oftentimes to note the assurance with which 
laymen will advise a mother that such and 
such a food is the only one for the baby, when 
they possess neither the intelligence nor the 
training necessary to judge of the child's di- 
gestive peculiarities or capacity; in fact, they 
know no more of the child's requirements or 
the chemical composition of the food sug- 
gested, or even what should be the com- 
position of the baby's food, than does the 
unfortunate babe itself. 

Outcome of the cases. — If there is inherited 
weakness, or a low vitality from any cause, 
the downward course may be very rapid. 
There are two or three weeks of suffering, 
and then the end. If seen before the vital 
powers are at too low an ebb, these children, 
by very careful and intelligent management, 
can be saved. 

Management. — They should be handled 
only when necessary for dressing and bathing. 



104 Malnutrition and Marasmus 

The nourishment given must at first be very 
weak, and its effects carefully watched from 
day to day, the strength and amount of the 
food being increased or decreased, as may 
be found necessary by the physician. A 
brine bath should be given daily, — a table- 
spoonful of salt to a gallon of water. The 
temperature of the water should be ioo° to 
1 05 F. The child should remain in the 
water ten minutes, being rubbed well with 
the hand while in the water. When removed, 
it should be placed in a large bath towel and 
dried quickly. — When dry, rub one table- 
spoonful of unsalted lard or goose-grease into 
the skin. Flannel should be worn next to the 
skin except during very warm summer 
weather. 

Marasmatic children when sleeping should 
not be allowed to remain long in one position ; 
they should frequently be turned from the 
back to the side, and from one side to the 
other. A hot-water bottle to the feet will 
often be necessary when sleeping. 

Airing. — To a child suffering from malnu- 
trition, fresh air is as indispensable as food. 
During the warm weather if he can be pro- 
tected from the sun the child should be kept 



Summer Diarrhoea 105 

out of doors from morning until night. 
During the entire year he should sleep with 
the window open. During the winter months 
he should be taken out of doors for at least 
two hours every pleasant day. When, on 
account of the inclement weather or excessive 
cold, he cannot go out, he should be dressed 
as for the daily outing, taken into a room all 
the windows of which have been open for at 
least one-half hour; here, placed in a baby- 
carriage and warmly covered, with a hot- 
water bottle at his feet, he is allowed to enjoy 
the fresh air for several hours each day. 
This brightens the eye, brings color to the 
cheek, and an invigorated baby returns to 
the nursery. 

SUMMER DIARRHOEA 

Summer diarrhoea is the cause of more 
deaths among young children in our large 
cities than any other one factor. So preva- 
lent and so dangerous an illness should be 
better understood by the laity than is the 
case at the present time. 

Nature of summer diarrhea. — Every illness 
of this nature must be considered as a case of 



io6 Summer Diarrhoea 

poisoning. The vomiting and diarrhoea are 
conservative efforts on the part of the organ- 
ism to get rid of the offending material. The 
poisoning may result from direct infection. 
It may be due to bacteria-laden milk, un- 
clean feeding apparatus, or to any means 
whereby poisonous germs find entrance into 
the gastro-intestinal tract. 

There may also be an indirect infection or 
self-poisoning — an auto-intoxication. Heat 
plays an important part in these cases. The 
child is greatly depressed; the digestive pro- 
cesses are not properly carried on — the milk 
taken from the breast or bottle is not acted 
upon by digestive juices of the usual strength 
and volume; decomposition takes place; 
poisons are generated and absorbed, produc- 
ing fever and prostration, the intestine en- 
deavors to empty itself of the offending 
material and diarrhoea results. 

Cholera infantum, inflammation of the 
bowels, dysentery — all very bad terms but 
in common use — are due primarily to the 
causes above mentioned. 

Management. — Such being the nature of 
summer diarrhoea, the duties of the mother 
in such cases should be clearly understood. 



Summer Diarrhoea 107 

The intestine must be relieved of as much as 
possible of the material which is causing the 
trouble. For this purpose give two tea- 
spoonfuls of castor-oil, and nourishment 
which will not furnish a fertile soil for the 
growth of bacteria. For this reason milk 
must be stopped with the first symptom of 
the trouble. The mother will never make 
a mistake in these cases; in fact, many a life 
will be saved by an immediate dose of castor- 
oil and by promptly stopping the milk diet 
before the physician who must always be 
called arrives. Milk, in addition to furnish- 
ing a medium for the growth of bacteria, 
forms into tough curds which must pass the 
entire length of the intestinal tract, exciting 
a very active peristalsis, causing pain and an 
increase in the number of passages. 

Milk substitutes. — The diet substituted for 
milk should consist of some cereal water, 
plain or dextrinized; either barley, wheat, or 
rice may thus be used; broths, whey, or 
substances of like nature may be given alter- 
nately or combined with the cereal waters. 
Salt should be added to the barley water if 
it is given plain. I prefer to give one or two 
ounces of chicken broth or mutton broth with 



108 Summer Diarrhoea 

the barley-water. A teaspoonful of sherry 
wine or one teaspoonful of liquid peptonoids 
may be added to the barley water. Broths 
must be given in small amounts, as not infre- 
quently they have a decidedly laxative effect. 

It is not advisable to give one food con- 
tinuously, as the child will tire of it. The 
addition to the barley water of one of the 
substances suggested will so change its taste 
that, if necessary, the diet may be continued 
for several days. The quantity should cor- 
respond to the amount of food taken in health, 
but the intervals between feedings should 
be shorter — every two hours if practicable. 
For instructions for cooking the cereal water, 
see Formula, page 324. 

How milk is to be resumed. — A patient is 
not to be considered out of danger nor should 
the milk diet be resumed until the stools 
are normal and not over two or three daily. 
In many cases milk must be excluded for 
two or three weeks. When it is resumed, 
care must be exercised in not giving too 
strong a mixture; many a relapse is due to 
this error. The first day not over one- 
quarter ounce of milk should be given in 
each feeding of the barley water. If this 



Summer Diarrhoea 109 

causes no disturbance one-half ounce may be 
given the next day, increasing from one- 
quarter to one-half ounce daily, if there is no 
return of the diarrhoea, until the customary 
strength is reached. Many children will not 
be able to digest nearly as strong a mixture 
as they were taking before their illness, and 
the diluted milk mixture will have to be sup- 
plemented by the use of dextrinized cereal 
gruels, cereal jellies, scraped beef, the white 
of an egg, and other easily digested sub- 
stances. Every year I have patients who, 
after an attack of diarrhoea cannot take a 
particle of milk without harm until the 
autumn is well advanced. 

Bowel irrigation. — Washing out the bowels 
once or twice a day is also very helpful in the 
treatment of these cases if the stools contain 
any blood or much mucus. This is done as 
follows: A No. 14 soft -rubber English cathe- 
ter, one that will not bend upon itself, if 
properly used, is attached to a fountain 
syringe. The bag should be held three feet 
above the patient, who should lie on the left 
side with the legs well drawn up. The tip of 
the well-oiled catheter is passed into the 
rectum a distance of two inches, when the 



no Summer Diarrhoea 

water is allowed to pass in slowly. Tfe 
water will distend the parts and facilitate 
the further introduction of the tube. Press 
the folds of the buttocks together until the 
colon is filled. This, in a child eighteen 
months of age, will require from twenty -four 
to thirty ounces of water. When not less 
than one pint has passed in allow the water 
to pass out alongside the tube. 

Prevention. — A word regarding the pre- 
vention of summer diarrhoea. It is not 
enough that the child be given properly 
prepared pasteurized or sterilized milk or 
breast-milk, — he must be made comfortable 
during the hot weather. The clothing should 
be of the lightest. On very hot days, if in 
the country, he should be kept in the open 
air, in the shade; if in the city, the coolest 
room in a house or an apartment is far better 
than the dusty streets. Whether in the city 
or country, on very hot days two or three 
fifteen-minute spongings with water at 6o° F. 
will add greatly to the child's comfort. 

Reduction of food. — Further, we know that 
the digestive capacity is lessened during the 
heated term, and the milk should be reduced 
in strength from one-quarter to one- third, 



Baths in 

adding boiled water to take the place of the 
milk removed. 

Cleanliness. — As infection may be carried 
to the feeding utensils by the hands of the 
nurse or mother, she should always wash 
them most carefully with soap and water 
before handling bottles or nipples, or pre- 
paring the infant's food. Inasmuch as other 
children may become infected, or reinfection 
take place in the one already ill, a child with 
summer diarrhoea should be isolated. 

BATHS 

The newly born child should be given daily 
a basin-bath with lukewarm, boiled water and 
castile soap until the cord falls and the navel 
heals. When this has taken place the tub- 
bath may be given. The temperature of the 
bath for the very young infant should not be 
below 95 F. nor above ioo° F. Very young 
children should not be kept in the water more 
than three minutes. After the third or 
fourth month a temperature of 90 or 95 
F. is best, the child being kept in the water 
about five minutes. At this age I prefer 
to have the tub-bath given at night, just 



ii2 Baths 

before the child is put to bed. A basin- 
bath may be given in the morning. When 
the child is a year old and fairly vigorous, 
the temperature of the water at the begin- 
ning of the bath should be 90° F. This 
should gradually be reduced to 8o° F. by 
the addition of cold water, the child being 
vigorously rubbed with the hand while in 
the water. The temperature of the room 
should be from 76 to 8o° F. during the bath, 
and windows and doors should be closed. 
When removed from the tub the baby should 
be dried quickly and thoroughly, and the 
folds of the skin should be well powdered. 
A sponge should never be used in any portion 
of the bathing process. It should never be 
included in the nursery outfit. It is never 
clean after it has once been used. 

Dread of the bath. — Some children have a 
dread of the bath, and cry frantically when 
placed in the water. This is due to fear, 
and may usually be overcome by placing a 
sheet over the tub and lowering the child 
on it into the water. 

The cold douche. — For "runabouts" from 
two to three years old it may not be wise to 
use water below 70 F., but many patients 



Baths 113 

over three years have the water applied in 
the form of a cold douche after the cleansing 
bath, during the entire twelve months at the 
temperature at which it runs from the faucet. 
In winter, in New York houses, this ranges 
from 50 to 6o° F. 

In giving the cold douche the child should 
stand in warm water covering the ankles. 
The douche may be used in the form of a 
spray or shower or the water may be applied 
by means of a sponge moistened with it at 
the desired temperature. The head, if the 
shower or spray is used, should be suitably 
protected by an oil-skin or rubber bathing 
cap. 

After the cold douche there should be a 
vigorous friction of the skin with a rough 
towel. If there is not a quick reaction, if the 
skin does not become warm and glowing, 
warmer water should be used. So also with 
blueness of the extremities and "goose flesh " ; 
use water less cold, but do not discontinue 
the douche. 

In the great majority of homes the bathing 
of the children can be carried on w r ith greater 
convenience immediately before their bed- 
time. The child should receive the warm 



ii4 Baths 

bath and the cold douche, and then, in 
night-clothes, a warm wrapper, and suitable 
foot covering, he should have his supper. 
However, if this time is not convenient, he 
may be given the evening meal at 5.30 or 
6.30, followed in one hour by the bath and 
bed. 

Tub-baths for fever. — Place the child in 
water at a temperature of 95 F. and reduce 
to 75 or 8o° F. by the addition of ice or 
cold water. The duration of the bath should 
not be more than ten minutes, constant fric- 
tion being maintained during the entire 
process. 

Basin bathing for fever. — Add eight ounces 
of alcohol to a quart of water at a tempera- 
ture of 70 F. The child is stripped and 
covered with a flannel blanket, and the entire 
body sponged with this solution for ten or 
fifteen minutes. 

Either the tub-bath or the basin-bath may 
be used by the mother in case of sudden high 
fever — 104 to 105 F. — before the physician 
arrives. She should be so instructed. 

Bathing for comfort in hot weather. — The 
basin-bath and tub-bath may also be used 
as a means of relief during very hot weather. 



Baths 115 

One or two basin-baths a day, with a tub- 
bath at bedtime during this trying season, 
will give the child much relief, and help him 
to pass safely through it. The very young 
feel the extreme heat most acutely, and 
endure it with difficulty. I know of nothing 
else that will give a restless, uncomfortable, 
heat-tormented child such a refreshing sleep 
as will a cool basin-bath. 

Mustard bath. — A mustard bath is pre- 
pared by adding a heaping tablespoonful of 
mustard to six gallons of warm water. One 
of the uses of the mustard bath is in the treat- 
ment of convulsions; it will be found useful 
also for nervous children who sleep badly. 
Two or three minutes in the mustard water, 
followed by a quick rubbing immediately 
before going to bed, is oftentimes all that 
will be required to induce refreshing sleep. 

Brine bath. — A brine bath — an even table- 
spoonful of salt to one gallon of water — is of 
great service with very delicate, poorly nour- 
ished children. Its action is that of a tonic. 
If the child is thoroughly soaped and washed 
with plain water, and then immersed in the 
brine bath, no further tubbing is necessary. 
The child should be kept in the bath for five 



n6 Baths 

or ten minutes, constant friction being con- 
tinued during the entire time. 

Soda bath. — The soda bath is of some ser- 
vice in cases of prickly heat from which many 
children suffer during the summer. A table- 
spoonful of bicarbonate of soda should be 
added to each half-gallon of water used. The 
temperature of the water should be that to 
which the child is accustomed. From two 
to four minutes in the water suffices. There 
should be little or no friction of the skin. The 
child should be dried with soft towels. 

Bran bath. — The bran bath also is of ser- 
vice in prickly heat. One cup of bran is 
mixed with the water in the bath-tub and 
the same method employed as for the soda 
bath. 

Starch bath. — The starch bath also is useful 
in prickly heat. One-half cupful of pow- 
dered laundry starch is mixed with the water 
in the bath-tub, and the same method em- 
ployed as for the soda bath. 

Hot bath. — Place the child for from three 
to five minutes in water which has been raised 
to a temperature of 105 to no° F. Con- 
stant friction of the extremities is maintained 
while in the water. 



Earache 117 

EARACHE 

Infants and young children are very sus- 
ceptible to attacks of earache. They usually 
occur in children who are suffering from some 
inflammatory condition of the throat or nose. 
Such, however, is not necessarily the case. 
I have seen earache in children who appar- 
ently were in perfect health. In the very 
young the only symptoms of the trouble may 
be restlessness, fever, which is usually pres- 
ent, and pain, which is manifested by crying. 
I have repeatedly seen an attack so severe 
as to cause an infant to shriek with pain, 
without any sign to locate the trouble. An 
older child, in addition to the above, will 
usually raise the hand to the side affected 
or point to the painful ear. The child usually 
is much disturbed if the ear is touched or 
manipulated in any way. While severe pain 
is the rule in ear disease, it may be absent; 
there may be loss of appetite, high fever, and 
restlessness for three or four days with no 
other sign of illness, and no evidence whatever 
of pain, when suddenly one discovers a yel- 
lowish discharge from the ear, with temporary 
or permanent relief from the symptoms. 



n8 Earache 

Management. — In case of an attack of 
earache, dry heat is of much service. Rest 
the ear on a hot- water bag, or apply a salt 
bag, made by sewing together two pieces of 
muslin about three by five inches in size and 
rilling it one-half full with salt. The bag 
and contents are then pressed flat, heated, 
and applied to the ear, the salt retaining the 
heat for a long time. Another device is to 
fill the finger of an old glove with salt, heat 
it, and place the tip in the ear. As an extra 
precaution the mother or nurse should first 
test it in her own ear. A douche at no F. 
may also be of considerable service in these 
cases; in my experience, earache is best re- 
lieved by this means. The child should be 
pinned in a sheet, and He on its back, with 
its head on a level with or a little lower than 
the body. A basin protected with a towel 
or absorbent cotton is placed under the ear. 
One assistant is required to steady the head, 
as the child will be sure to struggle. The 
douche bag — an ordinary fountain syringe — 
should be held not more than two feet above 
the child's head. From one to two pints of 
water may be needed. The tip of the syringe 
is placed about one-quarter of an inch from 



The Care of the Eyes 119 

the orifice of the canal and the water is 
allowed to flow into the ear until the child is 
relieved or until the bag is empty. Such a 
douche may be repeated every hour until 
medical aid arrives. 

Earache is usually due to the presence of 
pus or other fluid behind the drum mem- 
brane. This causes pressure within the ear 
which may require a slight operation for its 
relief. 

THE CARE OF THE EYES 

The eyes should always be well protected 
from the sunlight, the young infant never 
being allowed to lie with a bright light from 
a window streaming into its face. 

The eyes should be washed once daily with 
plain boiled water. A piece of soft old linen 
should be used and immediately burned. 
Before touching the eyes for any purpose, 
the hands must be washed with hot water 
and soap. 

No other home treatment of the eye is 
allowable, however slight the ailment. The 
custom of putting breast-milk into the 
eyes cannot be too strongly condemned. 



120 Dentition 

Teas of various kinds and proprietary or 
home-made eye-washes should never be 
used. Over 90 per cent, of the cases of 
blindness develop during early life, due to 
an infection which is neglected or badly 
treated. 

DENTITION 

Much has been written about the process 
of teething. Nearly all the ills of childhood, 
other than the contagious diseases, have been 
attributed to this cause. Not only the laity, 
but physicians, are often inclined to attribute 
this or that ailment to teething. Many a 
diagnostic puzzle has been smothered under 
the diagnosis of dentition. Observations 
covering the teething period of several thou- 
sand children in institution, out-patient, 
and private work, among all classes and 
conditions of children, have taught me to 
divide teething babies into three groups : the 
breast-fed, the well-managed bottle-fed, the 
badly fed. 

The breast-fed. — In the great majority of 
the breast-fed, the teeth appeared at the 
proper time, with little or no disturbance. 



Dentition 121 

Perhaps there was a period of irritability and 
restlessness for a few days before the teeth 
came through. In many, the teeth appeared 
without the slightest inconvenience, and 
that a tooth had been cut was discovered 
while washing or dressing the baby. In a 
very few breast-fed babies there was distinct 
irritability and restlessness, with fever and a 
slight diarrhoea, all of which subsided when 
the teeth appeared. 

The well-managed bottle-Jed, such as were 
given cows' milk and cream, properly pre- 
pared and diluted, teethed, as a rule, without 
inconvenience. Some showed a tendency 
to slight gastro-intestinal disturbance, which 
was relieved by diet and simple medication. 
The cases which occasionally developed 
severe intestinal disturbances were those 
which cut the first molars or several other 
teeth at one time during the hot weather. 
Such infants must be kept on a very light 
diet until the teeth are through, or until the 
onset of colder weather. 

The badly fed. — These were nearly all 
bottle-fed. They were given cows' milk 
improperly prepared or at too frequent inter- 
vals. Only condensed milk and the pro- 



122 Dentition 

prietary foods had been given some of these 
infants. To this class belong the great num- 
ber of infants who are given bread, meat, 
potatoes, and sweets before the digestive 
organs are ready for such food. It is these 
badly fed, debilitated, rachitic infants who 
are said to ''teeth hard." They teeth late, 
cut several teeth at one time, and have at- 
tacks of convulsions, diarrhoea, and vom- 
iting during the teething period. There is 
no doubt that the alimentary tract is pre- 
disposed to troubles of a catarrhal nature 
during active dentition. If the baby has 
been properly fed and is in fair health, this 
tendency is so slight that it probably will not 
be noticed. If, on the other hand, the diges- 
tive tract is weakened from abuse, vomiting 
and diarrhoea often result. 

The influence of rachitis. — The majority of 
children who belong to the third group are 
rachitic, and rickets always mean enfeebled 
resisting powers. Rachitic children teeth 
late. A rachitic boy under my observation 
cut his first tooth during the ninth month, 
and with the eruption of this tooth and with 
each of the five that appeared at intervals of 
two or three weeks during the next five 



Dentition 123 

months, an attack of vomiting and diarrhoea 
occurred, each attack subsiding when the 
tooth pierced the gum. 

Complications. — Irritability and restless- 
ness, slight fever and gastro-intestinal de- 
rangements, were the only unpleasant effects 
of dentition in any of my patients who were 
in fair health. The irritability, restlessness, 
and fever appeared to be due directly to 
dentition. Indirectly, teething may be a 
factor in gastro-intestinal derangements. 
The process may be painful, the digestive 
organs fail to act properly, and trouble 
follows. I have never known dentition to 
cause bronchitis, eczema, or skin eruptions 
of any kind. 

Possible dangers. — The opinion is very 
general among the ignorant, that bronchitis 
needs no treatment, and that diarrhoea is 
beneficial during the teething process. These 
beliefs, equally dangerous, have been the 
cause of an incalculable amount of harm : as 
the result, many lives are lost yearly. I have 
time and again seen children die with summer 
diarrhoea who were brought for treatment 
when no hope could be given. The mother 
had been told and believed that diarrhoea was 



124 The Teeth 

beneficial to the teething child, and that if the 
diarrhoea were stopped the child would be 
thrown into convulsions. 

Management. — When the form of a tooth 
can be made out pressing on the gum, and 
the child is fretful and feverish, the digestive 
capacity is lessened, as previously mentioned. 
When such is the case the nourishment should 
be temporarily reduced one-half by the addi- 
tion of boiled water. If the child is breast- 
fed, the nursing period should be reduced to 
five or six minutes, and boiled water given to 
drink between feedings. If a tooth is trying 
to force its way through a thick, resistant 
gum, a great deal of pain and discomfort 
will be spared the child if the tooth is assisted 
in its progress. This is best accomplished 
by the use of a clean towel, which is placed 
over the finger and vigorous friction brought 
to bear over the sharp edge of the tooth. 
It is quicker and less painful than lancing, 
and the gum will not close over the tooth. 

THE TEETH 
Twenty teeth comprise the first set. In 
the well child the first tooth usually appears 
between the sixth and the eighth months; 



The Teeth 125 

the first teeth may, however, in perfectly 
normal cases, come earlier or much later. 
I have known well, vigorous children who did 
not get a tooth until the thirteenth month. 
The first teeth are usually the two lower 
central incisors; generally the four upper 
incisors and the two lower lateral incisors 
appear between the eighth and the tenth 
months. The first four molars appear be- 
tween the twelfth and the fifteenth months; 
the eye- and stomach-teeth between the 
eighteenth and the twenty-fourth months; 
the four posterior molars between the twenty- 
fourth and the thirtieth months. This regu- 
larity in the appearance of the teeth is by no 
means constant even in well children. I 
have in several instances seen the upper 
lateral incisors appear first. In delayed 
dentition the teeth are very apt to appear 
irregularly. 

The care of the teeth. — As soon as the teeth 
appear they require attention. Until the 
second year is reached the mouth should be 
washed out at least twice a day with a solu- 
tion of boracic acid — one ounce to a pint of 
water. This can best be done by means 
of absorbent cotton wound around the tip of 



126 The Teeth 

a clean index finger and afterward dipped 
into the solution, when it should be applied 
with gentle friction to the gums and teeth. 
When a child is two years old it is well to 
begin the use of a soft tooth-brush, and a 
simple tooth powder composed of the follow- 
ing ingredients : 

Precipitated chalk, I ounce. 
Bicarbonate of soda, i drachm. 
Oil of wintergreen, a few drops. 

The child should also be instructed early 
as to the proper use of a quill tooth-pick. 

The milk-teeth are lost between the sixth 
and eighth years. They should not decay 
but fall out or be forced out by the second 
set. The teeth of every child over two years 
of age should be examined by a dentist every 
six months. If cavities are discovered in 
the first teeth they should be filled with a 
soft filling. 

The permanent teeth. — The permanent set 
comprises thirty-two teeth. The second 
dentition begins about the sixth year, and is 
usually completed about the twentieth year, 
although it may be delayed several years 



The Hair 127 

later. The permanent teeth appear in some- 
what the following order : 

First molars sixth year. 

Central incisors sixth to seventh year. 

Lateral incisors seventh to eighth year. 

First bicuspids ninth to tenth year. 

Second bicuspids ninth to tenth year. 

Canines eleventh to twelfth year. 

Second molars thirteenth to fifteenth year. 

Third molars after the eighteenth year. 

THE HAIR 

Whether the child should wear the hair 
long or short is a point upon which the doctor 
is likely to give unsought advice. There are 
two reasons why a child's hair should be kept 
short : 

1. From the standpoint of comfort. Dur- 
ing the hot months children perspire very 
freely both by day and by night. The heavy 
mass of hair which falls about the neck and 
shoulders adds greatly to the warmth and 
discomfort. I find that many children with 
long hair are poor sleepers and are irritable 
and hard to please when awake. In winter 
the child is very apt to perspire about the 



128 Nursery-Maids 

head and neck in active play, and runs a 
greater risk from exposure than if the exces- 
sive perspiration did not occur. 

2. The hair should be kept reasonably 
short, because then the scalp can be kept 
in a much healthier condition, and a much 
better growth of hair assured in later life. 

NURSERY-MAIDS 

The mother who can afford the expense 
of a helper should never take entire charge 
of her baby; nor should she share this duty 
with the maid of all work if better assistance 
can be secured. The child requires more 
attention than any one person should bestow. 
If one person is constantly in charge of a 
child it will either be neglected or the health 
of the mother or nurse will suffer and conse- 
quently her services be less efficient. Many 
a young mother has sacrificed her health 
because of a false sense of duty in this respect. 
The close confinement in itself would ruin 
her health and make her prematurely old. 
The children that are born later have less 
vigor, are more susceptible to illness, and 
start out handicapped in life as a conse- 



The Trained Nurse 129 

quence. The constant attention of the 
mother is not necessary; in fact, it is often 
injurious to the child. She is apt to handle 
the child too much, to overentertain it. A 
bright young woman should be secured as 
soon as the monthly nurse leaves, to as- 
sist in the care of the child. If she is a 
trained nursery-maid who has had previous 
experience of the right kind, she will be 
invaluable. In case a trained assistant is 
not to be obtained, any intelligent young 
woman of cleanly habits, and who is fond 
of children, may be trained at home in a 
few weeks. 

THE TRAINED NURSE 

If possible, a trained nurse should be em- 
ployed in every severe illness of childhood. 
She may alternate with the mother or nursery- 
maid in the care of the child. If the case is 
very urgent, two trained nurses should be 
employed. The nurse must never be ex- 
pected to work for more than twelve con- 
secutive hours. A tired nurse should never 
be in charge of a sick baby. 

The employment of a trained nurse does 



130 The Trained Nurse 

not mean that the mother may not perform 
many little offices for the patient, but the 
trained nurse should be in charge, and her 
opinions respected. 

Many an excellent mother makes a very 
poor nurse for her own child during a severe 
illness. Her great interest and anxiety 
impair her judgment. She is apt to become 
confused and fail to meet emergencies. A 
mother who is useless for a like office in her 
own household oftentimes makes an excel- 
lent nurse for her friend's child. The mother 
in the capacity of a nurse for her own infant 
is apt to fail under some of the following 
conditions : She is inclined to put more cloth- 
ing on the baby than the doctor advised. If 
a window is the means of ventilation, she has 
a strong inclination to close it a little beyond 
the point which the physician marked with 
a lead-pencil. The temperature of the sick- 
room is often kept higher than is good for 
the baby. Offices, the performance of which 
cause the child discomfort, are often not 
thoroughly attended to, such as washing the 
eyes, sponging off the patient in fever, syring- 
ing the ears, and adhering to a greatly re- 
stricted diet. These, and a few like offenses, 



Adenoids 131 

are pardonable in the mother, but they show 
us that in a severe illness trained help is indis- 
pensable. Further, I am very sorry to say 
that sometimes influences against carrying 
out the physician's directions in important 
particulars are successfully brought to bear 
upon the mother by well-meaning relatives 
and friends who possess no knowledge what- 
ever of the illness in question. 

ADENOIDS 

Adenoids are tumor-like growths that 
develop at the junction of the upper portion 
of the posterior pharyngeal wall and the 
vault of the pharynx. They may simply 
cover the surface of the parts in a spongy 
layer or they may fill the entire nasopharyn- 
geal space, completely blocking the passage 
from the nose to the throat. They are not 
to be considered as new growths, but rather 
as hypertrophies, or overgrowths, of the 
mucous glands and tissues of the parts. They 
may vary in size from a flaxseed to a walnut. 
Among the causes of adenoids may be men- 
tioned the use of the "pacifier" in infancy, 
repeated "colds" in the head, breathing 



132 Adenoids 

the dust-laden air of our large cities, mal- 
nutrition, and unhygienic living. While 
the taking of cold is a factor in the de- 
velopment of adenoids, my observation 
is that predisposition plays an important 
part. Many children have a tendency to 
glandular enlargement; in fact, in New York 
City, a large percentage of the children under 
ten years of age have adenoids. In a child 
under two years of age the naso-pharyngeal 
space is a very narrow slit; and since the 
majority of children up to the eighteenth 
month of life are sucking on something the 
greater part of their waking hours, the soft 
palate is forced back against the posterior 
pharyngeal wall, interfering with the drain- 
age of the parts, and on account of the fric- 
tion of the opposed surfaces congestion and 
irritation follow, resulting finally in a general 
hypertrophy. 

Age. — Very young children may have 
adenoids. The youngest patient that I have 
operated upon was eight months old. The 
majority of cases occur in children from 
eighteen months to six years of age. A slight 
amount of adenoid growth may cause no 
symptoms. A few summers ago I examined 



Adenoids 133 

the throats of forty children between the ages 
of two and five years, who came for treatment 
for other conditions. In thirty-seven, ade- 
noids were present. In twelve, operation 
was advised, and in five, operation was per- 
formed. In fifteen the growths were not 
sufficiently large to justify operation in the 
absence of annoying or dangerous symp- 
toms. 

The presence of adenoids is perhaps most 
often manifested by symptoms of chronic 
cold in the head. There is a great deal of 
discharge from the nose. The child has 
snuffles all winter. During summer there 
is little if any trouble. The child is said 
to take cold easily. The slightest exposure 
will cause a running at the nose. Cough is 
often associated with the nasal discharge, 
or it may follow it. The cough is worse at 
night; in fact, it often is not noticed until 
the child goes to bed. Such a cough was 
formerly known as "the nervous cough" or 
"the stomach cough." 

Mouth-breathing. — If the growths are large, 
we have mouth-breathing added to the other 
symptoms. The child breathes through the 
mouth both day and night for the reason 



134 Adenoids 

that the breathing space through the nose is 
choked. The night mouth-breathing gives 
rise to snoring; some of these children snore 
like adults. Almost every snoring child will 
be found to have either adenoids or enlarged 
tonsils, or both. 

In advanced cases the appearance of the 
face of the patient is characteristic. The 
habitual open mouth gives the face a stupid 
expression. In fact, such children are apt 
to be mentally dull. The nostrils are small 
and pinched. The upper lip is usually thick- 
ened. The voice is also affected; there is 
a decided nasal twang, and articulation is 
sometimes impaired. The child has trouble 
in blowing his nose. Occasionally adenoids 
are the cause of very severe nosebleed. In 
a small proportion of the cases hearing is 
impaired. Bed-wetting may be due to ade- 
noids. Recently a writer reported seven 
cases of inveterate bed-wetters, all cured by 
the removal of the adenoids. These children 
are more susceptible to diphtheria, and if 
they contract the disease it is apt to be more 
severe. For adenoids of any degree of sever- 
ity, complete removal is the only treatment. 
Sprays and the various local applications are 



Enlarged Tonsils 135 

absolutely worthless. The operation is prac- 
tically without danger. 

ENLARGED TONSILS 

Chronic enlargement of the tonsils is almost 
always associated with adenoids and is re- 
sponsible in a degree for their presence. We 
see many cases of adenoids, however, in 
which there is no tonsillar enlargement. 
Predisposition and repeated attacks of acute 
tonsillitis lead to chronic enlargement of the 
tonsils. Enlarged tonsils, when associated 
with adenoids, do not change the character 
of the symptoms of adenoids except to aggra- 
vate them ; therefore they should be removed 
as well as the adenoids. All other treatment 
in young children is useless. The operation 
in skilful hands may be said to be practically 
without danger. Parents always dread the 
operation, but the relief afforded the suffering 
child, and the knowledge that a serious ob- 
stacle to the child's growth and development 
has been removed, will repay them for their 
hours of anxiety. Gargles and sprays are of 
little or no value in chronic enlargement of 
the tonsils. 



136 Temperature — How to Take It 
MILK IN INFANTS' BREASTS 

It is not at all uncommon for an infant's 
breasts, at birth, to contain a substance 
resembling milk. When this occurs, the 
breasts are to be left alone and the milk will 
disappear. It is quite a common belief 
among hospital and dispensary patients that 
the milk should be pressed out. This is very 
wrong. In two cases I have known abscesses 
to develop after this treatment by a midwife, 
and in one case the child nearly lost its life. 

TEMPERATURE, AND HOW TO 
TAKE IT 

The normal rectal temperature of an infant 
varies between 98. 5 and 99. 5 F. The tem- 
perature should be taken in the rectum. The 
mouth is impossible, the groin and axilla 
absolutely unreliable. The child should lie 
on its stomach either in its bed or across the 
nurse's lap. Both the anus and the bulb of 
the thermometer should be well oiled. The 
bulb is passed into the rectum so that the 
mercury cannot be seen and allowed to remain 
three minutes. If the child kicks or struggles 



Appetite 137 

some one should hold its legs. Mothers are 
often disturbed because of a persistence of 
the temperature between 99. 5 and 100.5 F. 
While such a degree cannot be considered 
normal, it does not follow that it is of any 
consequence. This slight elevation may 
follow the acute illnesses such as grippe, 
pneumonia, and scarlet fever, and may con- 
tinue for weeks, without any harm resulting. 
Nervous, irritable infants will often range 
at ioo° F. for weeks at a time. In like 
manner children who are stimulated by 
playing with older children or with adults 
will often develop a rise in temperature 
which subsides as soon as the cause is 
removed. 

The thermometer should be washed with 
a one-per-cent. solution of carbolic acid after 
using. 

APPETITE 

It may be safely said that a well, vigorous 
child is a hungry child, and nearly every 
child may be made thoroughly hungry three 
times a day by suitable food at proper in- 
tervals. The children who come under my 



138 Appetite 

care for poor appetite, without evidence of 
disease to account for it, are, almost without 
exception, improperly fed. They are often 
given unsuitable food at meal-time, when 
they are loaded down with sweets and pas- 
tries; but the chief error is eating between 
meals. This habit has ruined more appe- 
tites and has been the cause of more stomach 
disorders than any other one factor. It is 
surprising what a large amount of candy, 
sweet crackers, and the like are disposed of 
in many households. Every year I am called 
upon to treat cases of loss of appetite in " run- 
abouts" from eighteen months to three years 
of age, who have what I have designated the 
milk habit. These children drink from five 
to six pints of milk a day, and refuse all other 
food. The milk satisfies the appetite but 
does not furnish the nourishment required 
for the rapid growth that takes place at this 
time, and the child in consequence suffers 
from malnutrition. He is pale, thin, and 
sallow in appearance, the sleep is poor, and 
the child is irritable and hard to please. We 
also see children at this age who suffer from 
improper nutrition on account of too re- 
stricted a diet. They take other food than 



Appetite 139 

milk, but not in sufficient quantity or variety. 
Some will refuse all kinds of vegetables, 
others will refuse all kinds but one or two; 
some will not take stewed fruit; others will 
not touch meat or eggs, no matter how they 
may be prepared; some will take but one 
cereal, others will refuse cereals altogether. 
The child's whims in these respects must 
never be catered to. He is to take what is 
placed before him or go without until the 
next meal. Likes and dislikes for various 
articles of diet are largely a matter of edu- 
cation, and the child may, and should, be 
taught to eat everything that is good for 
him. A little firmness in compelling him 
to go hungry for a few hours will soon do 
away with any childish fancy, which may 
be the cause of considerable harm. These 
children are rapidly growing, and for proper 
growth and development require a mixed 
diet. If the child is wedded to milk and 
refuses everything else, the milk must tem- 
porarily be discontinued. Some children 
with a poor appetite for solids will drink a 
glass or two of milk at the commencement 
of a meal. This satisfies the appetite for the 
time and nothing more will be taken. With 



140 Appetite 

such children the milk must be kept out of 
sight until the meal is completed, when one- 
half pint may be given. 

I have treated quite a number of cases of 
poor appetite and milk appetite in children 
otherwise well, in the following manner: 
The child is undressed and placed in bed 
and put under the care of one person as 
though he were very ill. The object in 
placing the patient in bed is to prevent his 
getting food other than that ordered. He 
is allowed water to drink in plenty. For 
the first day he is given four ounces of plain 
chicken or mutton broth every three hours. 
The second day he receives six to eight ounces 
of the broth at three-hour intervals. On 
the third day he is usually ravenously hun- 
gry and he is then given three or four good 
meals, when, if he has any special dislike 
for any article of diet, that is included in 
the first meal. In such cases it is surprising 
with what favor the formerly despised cereal, 
meat, egg, or vegetable will be looked upon, 
and it will thereafter have a cherished place 
in the child's heart. Some mothers will not 
be a party to such heartless treatment, as 
they are inclined to call it, but this is a wrong 



Habits 141 

view to take of it. A complete change of 
diet for a day or two would often be of benefit 
to all of us. With the child the advantage 
derived from thus learning to enjoy a mixed 
diet will favorably influence his health for 
the rest of his life. Change of climate, fresh 
air, out-of-door exercise, suitable food at 
regular intervals — all favorably affect the 
appetite. 

Children who over-exert themselves at 
school or at play or who are easily excited 
and have plenty of opportunity for excite- 
ment often suffer from loss of appetite. The 
management of these cases is to remove the 
source of the trouble, whatever it may be. 
An excellent means of bringing these chil- 
dren to a normal condition is an enforced 
rest for one and one-half hours after the 
noon-day meal. 

HABITS 

the pacifier; ear-pulling; mastur- 
bation 

Babies acquire habits most easily and at 
a very early age. Whether the habits are 
good or bad depends more upon the child's 



142 Habits 

attendants than upon the child itself. If 
properly trained — and the training must 
begin at birth — a baby will acquire the 
habit of taking his food at regular inter- 
vals by day and by night, and he will also 
acquire the habit of going to sleep and wak- 
ing at regular intervals. As a result of a 
careful regime regarding feeding, sleep, bath- 
ing, and airing, and the performance of its 
various functions at stated times every day 
the baby will soon develop into a ''little 
machine," as one mother called her babe. 
Such a child causes no trouble and thrives 
far better than one who is fed every time he 
cries, day or night. A baby that requires 
constant entertaining when awake, and that 
sleeps only when exhausted, usually has 
another bad habit, — that of being held 
constantly in arms. A baby should be 
handled very little, — just enough to give 
it exercise. It will learn to amuse itself at 
a very early age if given an opportunity. 

The "pacifier" habit — the habit of sucking 
a rubber nipple — is an inexcusable piece of 
folly for which the mother or nurse is directly 
responsible. The habit when formed is 
most difficult to give up. The use of the 



Habits 143 

" pacifier," thumb-sucking, finger-sucking, 
etc., make thick, boggy lips, on account of 
the exercise to which the parts are subjected. 
They cause an outward bulging of the teeth 
and a narrowing of the jaws, which are not 
conducive to personal attractiveness. Na- 
ture has not been so lavish of her gifts to 
the great majority of mankind that they can 
afford to trifle with her handiwork. Further- 
more, the "pacifier" is often a menace to 
health. If there are two or three young 
children in the family it is frequently passed 
around without other means of cleansing 
than being drawn a couple of times across the 
nurse's sleeve. This novel method of disinfect- 
ing the "pacifier" may be seen in actual use 
in the Park any pleasant day, and I have 
often seen the mother or nurse moisten the 
"pacifier" with her own lips before giving it 
to the child. I have seen young children 
fight for the "pacifier," one taking it from 
the mouth of another! It may readily be 
conceived what a boundless source of harm 
this little instrument may be, when every 
sort of disease known to childhood may 
be transferred by it. Thus it may act as a 
means of transmitting tuberculosis, syphilis, 



144 



Habits 



diphtheria, and many other ailments of minor 
importance. 

Adenoids, referred to in another chapter, 

are often the re- 
sult of thumb- 
sucking or the use 
of the "pacifier." 
The pressure ex- 
erted in sucking 
forces the soft pal- 
a t e against the 
posterior pharyn- 
geal wall ; this irri- 
tates and stimu- 
lates the glands of 
the part, which in 
time enlarge, and 
adenoids develop. 
To break the child of the "pacifier" habit, 
burn the "pacifier" and do not buy another, 
as is sometimes done. For thumb -sucking 
and finger-sucking, bandage the hands and 
moisten the bandage occasionally with a solu- 
tion of quinine. The "Hand-I-Hold Mit" 
(Fig. 7) is a useful means in breaking the 
habit. 

A few children develop the ear-pulling 




FIG. 



THE HAND-I-HOLD MIT 



Habits 145 

habit. It is always one ear which receives 
attention. Sometimes it is the lobe and 
sometimes the upper portion. The child 
pulls on the ear the greater portion of its 
waking hours. As a result of this practice, 
I have seen ears drawn entirely out of shape. 
Bandaging the hands so that the fingers can 
not be used to grasp the ear is the best 
means of breaking the habit. The "Hand- 
I-Hold Mit" may also be used with ad- 
vantage. 

Occasionally children are met with who 
have a mania for placing foreign bodies in 
the nose and ear. Shoe buttons are the favor- 
ites, although beans, pieces of coal, pebbles, 
and various other kinds of buttons serve the 
purpose when shoe buttons are scarce. The 
habit is best controlled by a vigorous spank- 
ing following each offence. 

Masturbation is one of the most injurious 
of habits. It consists in an irritation of the 
genitals by manipulation, by leg-rubbing, or 
by pressing the parts against some pointed 
object. Under the age of six years mas- 
turbation is more common in girls than in 
boys. My youngest was a girl only six 
months old. If the habit is not detected, 
10 



146 Habits 

masturbation may be practised for a long 
time and repeated many times a day. As a 
result, the child becomes irritable, loses sleep 
and weight, and is transformed into a con- 
dition of mental and physical exhaustion. 

The formation of habits and their cor- 
rection rests largely with the mother or 
attendant. Considerable stability is neces- 
sary for the correction of a bad habit, or the 
formation of a good one. It means several 
prolonged crying attacks on the part of the 
child and perhaps two or three wakeful 
nights. 

Management. — To cure the habit of mastur- 
bation, if the child is under eighteen months 
of age, the hands may be bandaged, or, what 
is better, a piece of tape may be fastened 
around each wrist and tied together at the 
back of the neck, making all secure with a 
safety-pin. The pieces of tape should be 
of sufficient length to allow the child free 
movement of the hands, but not long enough 
to allow them to come in contact with the 
genitals. 

Leg-rubbing is more frequently seen in 
very young girl babies. In such cases the 
wearing of a thick napkin or of two napkins 



The Normal Throat 147 

will usually prevent the practice. In some 
obstinate cases of leg-rubbing in older girls 
I have used a "knee crutch" with decided 
success. In children over two years of age, 
constant watchfulness and vigorous pun- 
ishment for each offense, combined with 
medical treatment, will cure most cases, 
although with some much difficulty will be 
experienced. 

The practice must be prevented and the 
genitals brought to a normal condition, when 
the patient will soon forget the indulgence. 

THE NORMAL THROAT 

Every mother should learn the appearance 
of the healthy throat, and every child should 
be accustomed to throat examination. It 
will soon learn that no harm is intended and 
force will not be required. The family phy- 
sician should demonstrate to the mother the 
color of the normal mucous membrane, and 
the size and appearance of the tonsils in 
health. By knowing the normal throat she 
will be able to recognize inflammation, swell- 
ing, and exudation in the form of the cheesy 
dots seen in tonsillitis, and the membrane 
in diphtheria. With the first appearance 



148 How to Examine the Throat 

of exudation of any kind, medical aid should 
be summoned. No chances should be taken 
with these cases. I know of fathers and 
mothers who will never cease to regret that 
they did not appreciate the dangers of tem- 
porizing with what they considered a "can- 
kerous sore throat." Diphtheria is most 
insidious in its onset and a sore throat should 
never be neglected. 

HOW TO EXAMINE THE THROAT 

(See Fig. 8.) 

In order to examine a baby's throat quickly 
and thoroughly the child must be held in 
front of and at the right side of the attend- 
ant, supported by the attendant's left arm 
under the buttocks; the right arm, which is 
thus left free, is passed around the child, 
binding its arms to its sides. The child's 
head rests upon the right shoulder of the 
attendant. 

The mother places her left hand on the 
child's head to steady it and with tongue 
depressor or teaspoon in her right hand she 
presses down the tongue, and, with the child 
under perfect control, she brings into view 



Sprue and Thrush 



149 



the parts that are to be examined. The 
most satisfactory view can be obtained by- 
daylight before a window. If the examina- 
tion is made in the evening, a lamp or taper 




FIG. 8. THE THROAT EXAMINATION 

held by a third party, a trifle above and 
behind the mother's right shoulder, will 
furnish a satisfactory illumination. 

SPRUE AND THRUSH 

Thrush consists of a parasitic growth 
which appears on the mucous membrane 



150 Sprue and Thrush 

of the mouth in young infants. The dis- 
ease makes its appearance in the form 
of small white masses about the size of a 
pinhead. The tongue and the inner side 
of the cheeks are favorite sites for the 
growth, although in severe cases the entire 
buccal cavity may be studded with it, causing 
it to look as though finely curdled milk had 
been scattered over the surface. The growth 
is firmly adherent, and if removed forcibly, 
slight bleeding results. It is usually asso- 
ciated with uncleanliness, and occurs, as a 
rule, in weakly and marasmic nurslings and 
in the bottle-fed, more frequently in the 
latter. It is rarely seen after the sixth 
month. 

In an infant with sprue, there is evidence 
of much pain and discomfort while nursing 
or while feeding from a bottle. The disease 
is not contagious. The average case may 
easily be cured in a week, if the directions 
for the treatment are carefully carried out. 
Active gastro-enteric disturbances, such as 
vomiting and diarrhoea, may be associated 
with sprue, but it is not the rule. Time and 
again I have seen cases of sprue in which 
there were absolutely no other signs of the 



Sprue and Thrush 151 

disease aside from the characteristic mouth 
lesions and the refusal of food. 

If the means of prophylaxis, which will be 
suggested, are used as the daily routine, the 
disease will never appear. 

Sprue in the breast-fed. — If breast-fed, the 
mother's nipples must be washed with a 
saturated solution of boric acid, and mois- 
tened with alcohol, diluted one-half, which is 
allowed to evaporate before each nursing. 
If bottle-fed, the nipple and bottle should be 
boiled after each nursing, the nipples turned 
inside out and scrubbed with borax water — 
one ounce of borax to a pint of water. 

The mouth toilet. — Whether breast-fed or 
bottle-fed, the mouth should be washed with 
a saturated solution of boric acid after each 
nursing. For this purpose a generous amount 
of absorbent cotton is loosely wrapped around 
the clean index-finger of the mother or nurse. 
This is placed in the cold solution, and with- 
out pressing out the water the finger is intro- 
duced into the child's mouth, and, in cases of 
sprue, brought gently in contact with the 
diseased parts, first with one side and then 
with the other, being pressed upon the 
tongue and under the tongue. It is well to 



152 Stomatitis, or Sore Mouth 

have the child rest on its side or stomach 
so that the fluid which is pressed out by 
the manipulation of the cotton against the 
cheeks and jaws can readily escape from the 
mouth. The washing, which really amounts 
to an irrigation, can be done in a few seconds, 
without the slightest danger of abrading the 
epithelium. 

Internal medication is of no value in sprue 
except in correcting any intestinal derange- 
ment that may exist, with a view to improv- 
ing the general condition. If the bottle 
or breast is refused, spoon-feeding for a few 
days may be necessary, and will hasten a 
cure. If the child is nursed, the mother's 
milk may be drawn with a breast-pump 
(see page 50), or pressed out with the ringers, 
and fed to the child. The domestic remedy, 
honey and borax, should not be used in any 
of the inflammatory diseases of the mouth 
in children. 

STOMATITIS, OR SORE MOUTH 

There are three varieties of this disorder — 

the catarrhal, the aphthous, and the ulcerative. 

In the catarrhal form there is redness 



Stomatitis, or Sore Mouth 153 

of the gums with excessive secretion of saliva. 

In aphthous stomatitis, distinct grayish- 
white plaques will be noticed on the inner 
side of the cheek and under surface of the 
tongue, varying in size from a pinhead to 
a split pea. 

Ulcerative stomatitis is the most serious 
disease of the three. It may occur during 
serious illness, but in most instances it occurs 
independently. There is a general con- 
gestion of the mucous membrane with the 
secretion of a great deal of saliva. Its dis- 
tinguishing point, however, is the line of 
ulceration which forms on the border of the 
gum at its junction with the teeth. The 
ulceration may be so severe as to cause a 
loosening and falling out of the teeth. The 
breath is often very foul, and the gums bleed 
at the slightest touch. 

Lack of cleanliness plays a large part in 
causing sore mouth. Unclean feeding appa- 
ratus, the use of the "pacifier," and the 
custom of allowing a baby to put into its 
mouth everything within reach account for 
a majority of the cases. 

The symptoms are fever, loss of appetite, 
and evidences of much discomfort when the 



154 Taking Cold 

child attempts to eat. In many cases of 
the ulcerative form there is high fever and 
greater prostration than one would think 
possible. 

The prevention and treatment are the same 
— cleanliness. The sore mouth should be 
washed with a saturated solution of boric 
acid after each feeding, using absorbent 
cotton, which is wrapped around the index 
finger. The cotton is saturated with the 
solution and gently brought into contact 
with the diseased surface. Force must not 
be used in these cases, as more damage than 
benefit will result if the tissues are lacerated. 
In the ulcerative form internal treatment is 
required in addition to the local means sug- 
gested. Every case of ulcerative stomatitis 
should be seen, at least once, by a physician. 

TAKING COLD 

By "taking cold" we understand that 
through the influence of cold upon some 
portion of the skin an impression similar in 
nature to that of shock is produced, which 
affects the entire body and manifests itself 
most frequently in the form of a congestion 



Taking Cold 155 

of the mucous membrane of the respiratory 
tract, between which and the skin there 
seems to be an intimate connection. Micro- 
organisms play an important role in the 
process. They are found in large numbers 
on the diseased mucous surfaces. The 
changes in the mucous membrane resulting 
from the exposure prepare the parts for 
their growth and development. The taking 
of cold usually means previous exposure, and 
what will constitute a sufficient degree of 
exposure in one individual may produce no 
effect in another. According to my observa- 
tion, the most frequent cause of colds in 
infancy is the action of cold air on a moist 
skin. The child that perspires readily, or the 
child that is made to perspire by unsuitable 
clothing, suffers most in this respect during 
the cold season. I look upon inadequate 
head-covering as a most frequent cause of 
diseases of the respiratory tract in the young. 
Most infants are dressed for the daily outing 
in a warm room, with the temperature rang- 
ing from 75 to 85 . The child is wrapped 
in ample coats, blankets, and leggings; he is 
active, throws his legs and arms about; the 
dressing thus far requires quite a period of 



156 Taking Cold 

time; he perspires freely, but the dressing 
is not completed. On the head is placed 
one of the more or less artistically decorated 
airy creations which are sold in the shops 
as children's caps. They furnish little pro- 
tection for the many square inches of the 
almost bald little head. The child is taken 
out of doors; a wind is blowing; the result 
is a cold, and how it came about is never 
understood. He was supposed to be dressed 
ideally for cold weather. The idea is com- 
mon and to a certain degree proper that a 
child's head should be kept cool. This 
theory, however, gives rise to carelessness 
as to the head-dress. During the colder 
months I advise mothers to make a skull-cap 
out of thin flannel, which the child can wear 
under the regular outing cap. 

Allowing a child to sit on the floor during 
the winter months is probably the next most 
frequent cause of taking cold. Kicking off 
the bedclothes at night is another frequent 
cause. Taking the child from a warm room 
through a cold hall is not without danger. 
Holding the child for a few moments by an 
open window during the cold weather is 
often followed by croup, bronchitis, and 



Taking Cold 157 

pneumonia. The uneven temperature of 
the living- and sleeping-rooms in many of 
our New York apartments is a very frequent 
cause of cold. Frequently during the day 
the temperature will be between 75 and 8o°, 
but at night, when the fires are banked, it 
falls to 55 or 6o° or lower. The child went 
to bed warm and perspiring, kicked off the 
bedclothes, the temperature in the room fell, 
the body became chilled, and the child took 
cold. 

Among rachitic children there is a marked 
predisposition to catarrhal affections; they 
acquire laryngitis and bronchitis upon very 
slight provocation. 

In many instances colds in infants are 
attributed to the bath. Among dispensary 
mothers this is often considered a cause of 
cold. I have never known a cold to be due 
to a bath. 

Colds-contagious. — Adults and " runabout' ' 
children with coughs and colds should not 
come in contact with infants. There is 
undoubtedly an element of contagion in such 
cases. It is a very bad practice to have a 
family pocket-handkerchief. The youngest 
infant is entitled to a handkerchief indepen- 



158 Taking Cold 

dent of the other children, and a handkerchief 
should never do service for more than one 
individual between washings. 

Prevention. — Mothers can do little without 
medical aid in the treatment of colds, but 
they can do much in preventing them. The 
temperature of the living-room should range 
from 70 to 72 F., the sleeping-room from 
6o° to 66° F. Of course it will be impossible 
to keep the temperature at all times at these 
figures, but the closer it approximates to 
them the safer the child will be. 

Children must not be allowed to sit on the 
floor during the winter. They can have 
their playthings on the bed, on the sofa, or 
in a clothes-basket, which may be raised on 
two thick pieces of wood or a couple of books. 
There is always a draught near the floor. 
The "pen," referred to on page 318, is the 
best scheme that I know of for keeping 
children from the floor. 

The room in which the child is dressed 
for an outing should not be above 70 F. 
Securely pinning bed-blankets to the mat- 
tress, or, better, a combination suit with 
"feet" will do much to prevent the child 
from taking cold at night. 



Cough 159 

COUGH 

The most frequent cause of the temporary 
cough seen daily in children's work is almost 
always an acute inflammatory condition of 
the mucous membrane of the respiratory 
tract, involving usually the fauces, the 
larynx, and bronchi, subjects which are 
referred to under their respective headings. 

Chronic cough. — Ninety -five per cent, of 
the obscure coughs are due to adenoid vege- 
tations in the naso-pharyngeal vault. In- 
cipient tuberculous infiltration in any portion 
of the lungs or pleura may produce the per- 
sistent cough. Thorough physical exami- 
nations and careful observation of the case 
for a few days will make a diagnosis possible. 
Whooping-cough without the whoop or 
vomiting may cause a persistent cough. It 
runs its course and subsides in from four to 
eight weeks. A diagnosis of such mild cases 
of whooping-cough is possible only when 
there is a history of exposure to the disease. 
I have had occasion to examine and treat 
many children who were brought to me 
because of a "cough" which had not been 
controlled by the measures employed. While 



160 Cough 

we hear much of the cough of teething, the 
" stomach cough," the "nervous cough, " 
and the "habit cough," it has never been 
my lot to see a case in which the cough was 
not connected in some way with the respira- 
tory tract. Thorough examination of these 
cases, perhaps repeated examinations, will 
be required before the site of the trouble is 
definitely located, when it will almost in- 
variably be found somewhere in the respira- 
tory tract. The stomach cough, the nervous 
cough, and the teething cough formerly stood 
for the persistent cough which could not be 
accounted for by physical examination of 
the chest or by mere inspection of the throat. 
They are frequently referred to by the older 
writers. An elongated uvula, to which these 
obscure coughs have also been attributed, is 
very rarely a cause. The history is usually 
only that of a persistent cough. It may be 
irritating in character, keeping the child 
awake at night, or it may be paroxysmal, 
the attacks being more severe when the child 
is lying down. Many times the paroxysms 
are so severe, being particularly worse at 
night, that whooping-cough is suspected be- 
cause of the absence of chest signs. 



Cough 161 

Cough due to adenoids. — An immense 
majority of these obscure coughs in children 
are due to adenoid vegetations with or with- 
out enlarged tonsils. A child with such a 
cough may have the typical adenoid face, 
mouth-breathing, and other signs referred 
to (see Adenoids, page 131), or these symp- 
toms may be entirely absent. It is the 
latter type of case that is particularly 
puzzling and apt to be overlooked. On 
account of the absence of mouth-breathing 
and other symptoms of nasal obstruction, 
the possibility of adenoid vegetations has 
been ignored. In these cases careful inquiry 
will usually elicit the history of frequent 
colds, or what is styled "catarrh," as there 
is more or less serous discharge from the 
nose, or the child is said to "take cold in 
the head easily." Digital examination of the 
naso-pharyngeal vault will reveal a fringe 
of soft adenoid growth at the upper portion 
of the posterior pharyngeal wall, not large 
enough to produce obstruction, but actively 
secreting. This secretion, if not profuse, 
is partially evaporated in the nostrils, or if 
profuse, is discharged from the nostrils or 
passes backward over the posterior pharyn- 

XX 



1 62 Cough 

geal wall, thus provoking cough, when the 
child is up and about. When the child 
rests on his back, the secretion naturally 
flows over the posterior pharyngeal wall, 
and a cough is the result. Time and again 
I have relieved the most obstinate cough 
by curetting and removing this sponge-like 
tissue. In one patient, a boy two years of 
age, who had been coughing hard for ten days 
with paroxysms and vomiting, a diagnosis 
of whooping-cough had been made by a 
member of the family who had seen many 
cases of whooping-cough, and also by myself. 
Adenoids were found to be present in a slight 
degree. Their removal was advised, with 
the idea of making the coughing attacks less 
severe, when, greatly to our surprise, the 
coughing ceased at once, not a paroxysm 
occurring after the growth was removed. 
The cough was due to the adenoid vegeta- 
tions and not to whooping-cough. 

Cough caused by tracheitis. — Tracheitis (in- 
flammation of the windpipe) will produce 
a cough, severe and intractable, with no 
signs in the chest. In these cases, however, 
the cough is usually sudden in its develop- 
ment. It is often accompanied by slight 



Tonsillitis 163 

fever, and if the child is old enough he will 
aid us by referring to the sense of discomfort 
and tightness which exists over the upper 
portion of the chest. Sometimes the sensa- 
tion will be described as a burning, which is 
located directly over the trachea. 

TONSILLITIS 

Tonsillitis, or inflammation of the tonsils, 
is a very common ailment among children 
during the colder months. It usually fol- 
lows exposure. The onset is generally sud- 
den, with high fever — 103 to 105 F., — 
pain, swelling, headache, and general mus- 
cular soreness. Inspection of the throat 
will show the tonsils to be swollen and in- 
flamed. The entire throat generally has 
a congested appearance. No other changes 
may be noticed. In the majority of cases, 
however, the tonsils will be found studded 
with small white dots of a cheesy material. 
If the case is seen two or three days after 
the beginning of the illness the dots may 
have coalesced, forming large yellowish 
patches which so closely resemble the appear- 
ance of the throat in diphtheria, that it may 
be impossible for the physician without the 



1 64 



Cold in the Head 



aid of a microscope to differentiate between 
the two diseases. An attack of tonsillitis 
runs its course in from two to five days. 
Management. — Cold applications, cold 
compresses (see cut) to the throat, and cold 




FIG. 9. COLD COMPRESS 

spongings of the body afford the patient 
much relief. A dose of castor-oil given at 
the first symptom of the disorder will always 
be of value. 

COLD IN THE HEAD (CORYZA) 

A cold in the head is a very frequent 
occurrence in the young, and while not 



Cold in the Head 165 

serious if the trouble limits itself to the 
mucous membrane of the nose, it is, never- 
theless, a source of much annoyance to both 
mother and child. The mucous membrane 
of the nasal passages is congested and swollen. 
The nostrils of infants in health are very- 
narrow, so that a slight congestion will 
greatly interfere with the breathing. 

The first sign to be noticed is that when 
the child is nursing he is unable to breathe 
easily through the nose, and frequent rests 
are necessary. Sleep, for this reason, is also 
interfered with. The baby sneezes more than 
usual and there is a watery discharge from the 
nose with usually a degree or two of fever. 

Management. — With the onset of the first 
symptoms, one teaspoonful of castor-oil will 
be of service. A few drops of melted vaseline 
or liquid alboline may be dropped into the 
nostrils every two hours. 

The danger from a so-called "cold in the 
head" rests in the fact that the inflammation 
does not always limit itself to these parts. 
It is very liable to extend to other portions 
of the respiratory tract, terminating some- 
times, even if properly treated, in bronchitis 
or broncho-pneumonia. 



166 Bronchitis 

BRONCHITIS 

Bronchitis may occur as a primary illness, 
or it may follow a cold in the head, laryn- 
gitis, or any inflammatory condition of the 
respiratory tract. It often occurs as a com- 
plication of other diseases. There is almost 
always more or less bronchitis with measles. 
In bronchitis we have a serious illness not 
necessarily serious in itself but mainly so 
because of the frequency with which it leads 
to catarrhal pneumonia. Bronchitis in a 
delicate child requires but a little bad man- 
agement or neglect and pneumonia will 
surely develop. 

The reason why bronchitis is a dangerous 
illness in a young child is because of the lack 
of development of the parts which form the 
chest walls. The ribs are soft and the mus- 
cles weak. The bronchial tubes collapse 
readily. In an older child the bronchial 
secretions are coughed into the mouth and 
swallowed or expectorated. The young in- 
fant cannot expectorate. When the secre- 
tion is viscid and thick, the weak chest-wall 
fails to furnish the power required to expel 
it and instead it is drawn deeper into the 



Bronchitis 167 

lungs, the smaller tubes become clogged 
with mucus, the air vesicles collapse, bac- 
teria multiply rapidly in the confined secre- 
tions, and pneumonia results. 

Bronchitis is indicated by coughing and 
wheezing, and what the mother often calls 
"a drawing of the chest." In many cases 
fever is present in a marked degree. The 
severity of the cough and the other symp- 
toms depend entirely upon the severity of 
the lesions. In many cases, if seen early 
the disease will respond to treatment in a 
day or two. 

Management. — A generous counter-irrita- 
tion of the chest with one part of turpentine 
and three parts of camphorated oil is a useful 
measure, the applications to be made twice 
a day — morning and evening. What is 
better, however, is the use of the mustard 
plaster, made by mixing one part of mustard 
with three parts of flour, sufficient warm 
water being added to make a paste, which 
may be spread on cheese-cloth or thin muslin. 
It should be large enough to encircle the 
chest, fitting the child like a jersey. This 
is covered with another piece of similar 
material and the plaster is complete. It 



168 Croup 

should be wrapped around the chest and 
allowed to remain from ten to fifteen minutes 
— until the skin is thoroughly reddened. 

Proprietary cough mixtures and home 
remedies should never be relied upon for 
the treatment of bronchitis in children. 

CROUP 

CATARRHAL CROUP; DIPHTHERITIC CROUP 

There are two varieties of croup, catarrhal 
and diphtheritic: catarrhal croup is a catarrhal 
inflammation of the larynx, and diphtheritic 
croup a membranous inflammation of the 
larynx. 

Catarrhal croup may begin in two ways. 
The child will suffer from snuffles, indicating 
a simple cold in the head, which is followed 
by a slight fever and a mild cough. The 
cough rapidly becomes worse and is hoarse 
and barking in character, becoming more 
severe toward evening. As a rule, the fever 
is not high. In the evening of the second 
or third day of the illness, sometimes the 
first day, signs of obstruction to the breath- 
ing become apparent. The inspiration is 



Croup 169 

labored and accompanied by a croaking 
sound. The child cannot speak above a 
whisper. 

Probably not over half of the cases show 
this gradual development. In many the on- 
set is sudden : the child goes to bed as well as 
usual; after a quiet sleep of a few hours he 
awakes suddenly, sits up in bed, and with 
high-pitched cough, straining for breath, he 
startles the household. 

Membranous or diphtheritic croup is much 
the more dangerous affection, but to the 
mother there is no means of distinguishing 
between the two forms, unless the child has 
diphtheria and the croup follows. The two 
forms may appear in identically the same 
way, although the onset of the diphtheritic 
croup is usually more gradual. 

Management. — In case of a severe cough or 
a sharp attack of croup in one of the children, 
the mother or nurse in charge has three 
duties to perform : send for the doctor, isolate 
the child, and give him a teaspoonful of the 
syrup of ipecac, which may be repeated in 
fifteen minutes if there is no vomiting. Every 
case of croup should be quarantined until the 
nature of the trouble is determined. If it 



170 



Croup 



is catarrhal, no harm will be done by the 
isolation. If it is diphtheritic, the lives of 




FIG. 10. THE HOLT CROUP-KETTLE 



other members of the household may be 
saved by the precaution. If a croup-kettle 
is at hand (see cut 10), it should be brought 
into use after making a tent by covering or 
draping the crib with a sheet (see cut n). 



Croup 



171 



One teaspoonful of tincture of benzoin or 
pine-needle oil is added to one quart of 




FIG.II. CRIB PREPARED FOR STEAM INHALATION 



water and placed in the kettle, which is 
heated by the alcohol lamp attachment. A 



172 Pneumonia 

cold compress (page 164) applied to the 
throat is often beneficial also. It should be 
thoroughly wrung out, covered with some 
dry material, and changed every twenty 
minutes. The child should receive a laxa- 
tive as early as possible in the attack. 

PNEUMONIA 

Pneumonia, sometimes referred to as in- 
flammation of the lungs, or lung fever, 
occurs very frequently in infants and young 
children. It may appear as an independent 
affection or as a complication of other dis- 
eases. There are two varieties which are 
commonly met with in the young: lobar 
pneumonia, which corresponds closely to the 
adult type, and broncho -pneumonia, or, as 
it is sometimes called, catarrhal pneumonia. 

Lobar pneumonia usually results from 
exposure — a sudden chill of some part of the 
surface of the body. 

Broncho-pneumonia is usually the outcome 
of bronchitis or what is known as "a common 
cold." 

The latter is most frequently seen in chil- 
dren and is usually the variety which occurs 



Pneumonia 173 

as a complication of other diseases. The 
mode of onset of the two types varies. 

Lobar pneumonia. — With lobar pneumonia 
the onset is sudden ; there may be a chill or a 
convulsion. Sometimes vomiting ushers in 
an attack. The fever rises rapidly to 103 
or 105 F. The face is flushed and wears an 
anxious expression; the breathing is rapid, 
the respirations being from 40 to 60 a minute, 
the expiration being accompanied by a 
peculiar, partially suppressed sigh. The 
child is very restless, often delirious, or 
there may be stupor, with symptoms point- 
ing to a complicating meningitis. All the 
symptoms disappear with the advent of the 
crisis, when the fever suddenly abates and 
fails to rise again. The crisis may be ex- 
pected any time between the third and 
eleventh day of the recovery cases. In the 
majority of my cases it has occurred from the 
fifth to the seventh day, in a few not until 
the ninth day, and in two it did not occur 
until the eleventh day, and in one on the 
fourteenth day 

The prognosis of lobar pneumonia in 
children is good. A very small percentage 
fail to recover. A patient of mine, a three- 



174 Pneumonia 

year-old boy, passed through two distinct 
attacks in a single winter, the second after 
an interval of ten weeks. 

Broncho-pneumonia. — In catarrhal or bron- 
cho-pneumonia the story is different. There 
may be a pneumonia at the commencement 
of the illness, but according to my observa- 
tion, which covers several hundred cases, 
the majority begin with symptoms of a 
common cold or bronchitis, the lungs becom- 
ing involved gradually. In other words, the 
onset is gradual, not sudden, whether it 
occurs independently or as a complication of 
some other disease. There is cough, often 
distressing, moderate fever, rapid breathing, 
loss of appetite, and, later, emaciation. 
Broncho-pneumonia in children is an affec- 
tion of extreme gravity. There is no well- 
defined crisis as in lobar pneumonia. The 
disease may last a week or two weeks, or it 
may continue for months. In one of my 
cases — a child eighteen months of age, — the 
disease continued three months before the low 
fever abated and the lungs were clear. The 
recovery cases often require from three to 
four weeks before the lungs may be considered 
normal. 



The Contagious Diseases 175 

Care and prevention. — The sick-room of a 
patient ill with pneumonia should be large, 
with one window open at least four inches 
from the top on the coldest days. The 
temperature of the room should not be below 
55 F. or above 65 F. The child should be 
put on a reduced diet of animal broths, thin 
gruels, and diluted milk. 

Prevention resolves itself into proper care 
of the child, proper clothing, avoidance of 
unnecessary exposure, and an appreciation 
of the fact that with a child it is almost as 
necessary to call a physician for a common 
cold or bronchitis as it is for scarlet fever or 
diphtheria. 

THE CONTAGIOUS DISEASES 

A contagious disease is one due to a specific 
poison which under favoring conditions pos- 
sesses the power of reproducing itself in 
the person of another. The poison of the 
disease, the contagium, may be transmitted 
either directly by contact with an individual 
suffering from the disease, or indirectly by 
means of some person or object, such as the 
clothing or hands of the attendants, which 



176 The Contagious Diseases 

have been in contact with the one infected. 
According to my observation, personal con- 
tact with the infected is required in a large 
proportion of cases. Measles and whooping- 
cough are unquestionably the most con- 
tagious diseases of this type, requiring for 
their transmission only a very slight ex- 
posure. German measles and chicken-pox 
are next in order of communicability, while 
scarlet fever is less contagious than any of 
those mentioned — a close contact and a 
fairly long exposure being usually required. 
Clothing may be infected by the contagium 
of scarlet fever and diphtheria, the poison 
remaining inactive for a long time. 

Incubation period. — By this we understand 
the time usually required for the disease to 
develop after exposure. 

Diphtheria variable. 

Scarlet fever five to seven days. 

Measles nine to twelve days. 

Whooping-cough. . .seven to fourteen days. 

Chicken-pox fourteen to twenty-one days. 

Mumps ten to twenty days. 

German measles . . .two to three weeks. 

Diphtheria through personal contact alone 



Scarlet Fever 177 

is probably the least contagious of any of 
the diseases belonging in this group. Its 
virulence, however, renders every preventive 
measure imperative. 

Smallpox, thanks to compulsory vacci- 
nation, is seen so rarely that it need not be 
considered here. 

SCARLET FEVER 

Scarlet fever is one of the most important 
of the contagious diseases, and whether a 
case is mild or severe it requires the greatest 
watchfulness on the part of both physician 
and nurse, nor can their vigilance be safely 
relaxed until the patient has been apparently 
well for at least five or six weeks. 

Incubation. — The period of incubation 
varies considerably. In the majority of cases 
the first sign of trouble is noticed from three 
to five days after exposure. In one of my 
cases twelve days elapsed between the time 
of exposure and the initial symptom. If, 
however, nine days pass without evidence of 
illness, the child may ordinarily be considered 
safe, but the exposed should not come in 
contact with other children until at least four- 



178 Scarlet Fever 

teen days have elapsed. Infection usually 
takes place from direct contact, although the 
contagium, the nature of which is unknown, 
may be carried by means of clothing, toys, 
books, or a third person. Doctors who do 
not wear gowns while attending scarlet fever 
patients, and are careless about washing 
their hands after examining such cases, 
may themselves carry the disease. One 
attack usually protects against a second, 
although cases are on record of the occur- 
rence of two or three attacks in the same 
individual. 

The onset. — The onset of scarlet fever is 
sudden, often with vomiting, occasionally 
with a convulsion, always with fever and sore 
throat. The fever is usually high, 103 to 
105 F., though it may be low, — 101 to 102 
F. When the latter is the case the course of 
the disease will probably be mild. Whether 
the fever is high or low, the deeply red, con- 
gested throat is usually present. 

The rash. — From twenty-four to thirty- 
six hours after the initial symptom the rash 
makes its appearance. In many mild cases 
it will be the first symptom noticed. The 
character of the rash, its intensity, and the 



Scarlet Fever 179 

height of the fever indicate fairly well the 
severity of the attack. The chest and abdo- 
men are usually the site of the first appear- 
ance of the rash. It is composed of minute 
red dots so closely set together as to give the 
skin a deep scarlet color. The extent of the 
rash varies greatly; in some cases it covers 
the entire body and lasts from six to seven 
days. In others, it is much less distinct, 
covering only limited areas, and may last 
for only a few hours. In one of my cases it 
was visible for only six hours after it was 
first noticed; while in all other respects the 
case was one of typical scarlet fever. 

Desquamation. — Ordinarily the rash begins 
to fade about the fourth or fifth day and is 
followed by the desquamation period. This 
is also variable in extent; there may be but 
a light peeling of the palms of the hands, 
and of the finger-tips about the nails, or it 
may be most profuse, the epidermis peeling 
off in large flakes from the entire surface of 
the body. From two to three weeks are 
required to complete this process. 

Complications. — Complications are a com- 
mon occurrence in scarlet fever, and it is the 
complications which are usually the cause of 



180 German Measles 

death in the fatal cases. The kidneys, heart, 
lungs, and ears are particularly liable to 
serious involvement. 

An error frequently made is to allow the 
child convalescent from scarlet fever to be 
out of bed too early. He should never be 
allowed to run about before four, or, better 
still, five or six weeks have elapsed. The 
peeling may be hastened, the disease cur- 
tailed, and the danger of spreading lessened 
by a daily sponge bath followed by an inunc- 
tion with sweet oil or vaseline. 

GERMAN MEASLES 

German measles is a contagious disease 
of a very mild type, ordinarily the rash being 
the first sign of illness. This may have been 
preceded, however, by a slight chilliness and 
soreness of the muscles. The eruption is of 
a reddish-brown color and appears more 
extensively on the face and chest than on 
other parts of the body. The spots vary 
in size from a pin-head to a flaxseed. In 
well-developed cases the rash may cover 
the entire surface of the body. The tem- 
perature is usually low and lasts but a day 



Mumps 181 

or two. I have never seen it above 102° F. 
There is little or no inflammation of the 
eyes, nose, or throat, in marked contradis- 
tinction to measles. There is no cough and 
the child suffers very little inconvenience. 
The glands behind the ear and at the sides 
of the neck are almost always enlarged and 
sensitive, — this with the fever and the rash 
comprising the chief symptoms of the disease. 
The duration of the rash varies from one to 
three days. Usually at the end of forty- 
eight hours the skin will be found clear. 

My treatment is : two or three days in bed 
and a light diet. 

MUMPS 

Mumps is an inflammation of one or both 
parotid glands. One attack usually pro- 
tects against another. The disease is usu- 
ally acquired by contact with the infected. 
It is extremely doubtful that it can be car- 
ried by a third party. The period of time 
required for the development of the disease 
after exposure varies considerably; but from 
ten to twenty days may be considered the 
period of incubation. 



1 82 Mumps 

The first symptoms are similar to those 
of the other contagious diseases. There 
is loss of appetite, headache, languor, and 
slight fever. In addition to these general 
symptoms, the child complains of pain upon 
swallowing, or upon moving the jaw. Vine- 
gar or any acid substance taken into the 
mouth causes considerable pain or discomfort 
behind the jaws and under the ears. In a 
few hours there will be noticed a swelling 
of the parotid gland in front of and under 
the ear. Both sides rarely begin to swell 
at the same time; the swelling of one gland 
usually precedes that of the other by a 
couple of days. It increases gradually for 
two or three days until it reaches its height, 
when it begins to subside slowly, reaching 
the normal in eight or ten days from its 
beginning. The temperature during the at- 
tack ranges from ioo° to 103 F. 

The complications of mumps in children 
are few, and the disease cannot be regarded 
as dangerous. Acute Bright's disease fol- 
lowed an attack of mumps in one of my 
patients. Swelling of the testicles is a 
comparatively rare occurrence. Ear disease 
is an infrequent but possible complication. 



Whooping-Cough 183 

Multiple abscesses may develop in the parotid 
gland, but this is also a very rare occurrence. 
Other acute glandular swellings at the angle 
of the jaw are often mistaken for mumps; 
in mumps, however, the swelling is always 
in front of, under, and behind the ear. A 
simple glandular enlargement may be located 
at any point under or behind the jaw. 

Management. — A child with mumps should 
be kept in bed until the swelling has subsided, 
and given plain, easily digested food. The 
mouth should be rinsed after each meal with 
a saturated solution of boracic acid. For the 
pain and discomfort caused by the swelling, 
hot applications answer best. Flannel wrung 
out of very hot water and bound upon the 
parts always furnishes some relief. The 
flannel should be kept hot by repeatedly 
dipping it into hot water. The heat will 
be retained better if the flannel is covered 
with oiled-silk. 

WHOOPING-COUGH 

In whooping-cough we have one of the most 
dangerous diseases of childhood, dangerous 
in the extreme for the very young, the deli- 



1 84 Whooping-Cough 

cate, and the rachitic. In itself it is seldom 
directly fatal, but the frequent complica- 
tions of catarrhal pneumonia in winter 
and intestinal diseases in summer make it 
indirectly responsible for the loss of many 
lives. 

The period of incubation ranges from 
seven to fourteen days. At the commence- 
ment of the disease the cough is not severe 
and often cannot be distinguished from that 
of bronchitis or a common cold. The cough, 
however, does not respond to treatment 
for coughs and colds; it increases in severity, 
becoming paroxysmal in character and worse 
at night. During the paroxysms the eyes 
water, the face becomes red and congested, 
the seizure often ending in vomiting. The 
characteristic whoop usually develops after 
ten days or two weeks. In the mild cases 
there may be but two or three paroxysms 
daily; in the severe cases there are usually 
from twenty to thirty in twenty-four hours. 
I have seen a few cases in which the disease 
was so mild that the whoop never appeared, 
while others whooped but once during an 
entire attack. The disease varies not only 
in its severity, but in its duration as well. 



Whooping-Cough 1 85 

Occasionally cases are seen which run the 
entire course in four weeks; unfortunately, 
they are rare. As a rule, from eight to ten 
weeks elapse before the child may be con- 
sidered well. 

As long as the child continues to whoop, 
or the cough is distinctly paroxysmal, it is 
not safe for him to come in contact with 
the unprotected. The active stage, during 
which the paroxysms are frequent and 
severe, rarely lasts longer than two or three 
weeks. 

Recurrence of the whoop. — Sometimes after a 
period of three or four months without whoop- 
ing, the child takes cold, develops a cough 
paroxysmal in character, and the whoop 
returns; but this does not mean that there is 
a return of the whooping-cough, and such 
children need not be quarantined. 

Management. — Whooping-cough cannot be 
cured; it must run its course. The author's 
observations, which cover the management 
of over fifteen hundred cases, prove that 
every case may be ameliorated and its course 
perhaps shortened. The home treatment 
demands an abundance of fresh air. The 
child should spend the greater part of every 



186 Diphtheria 

pleasant day out of doors and sleep with the 
window open an inch or two from the top, 
regardless of the weather. 

There are certain drugs which appreciably 
relieve the paroxysm, but they must always 
be ordered by a physician. 

DIPHTHERIA 

Diphtheria is a disease due to a germ 
which is known as the Klebs-Loeffler bacillus. 
The mucous membrane of the throat or nose 
are the parts primarily attacked. The dis- 
ease is usually of slow and insidious onset, 
requiring two or three days for its complete 
development. The period of incubation 
varies greatly : a child may develop diphtheria 
within twenty-four hours after exposure, or 
it may be delayed a month or six weeks. In 
children who have been exposed, there should 
be a microscopical examination of the secre- 
tion from the throat, which may settle the 
question as to the child's liability to contract 
the disease. 

The first symptoms are fever and rest- 
lessness, loss of appetite, and disinclination 
to play. The child may complain of pain 



Diphtheria 187 

upon swallowing, and in many cases, very- 
early in the attack, swelling may be noticed 
at the angle of the jaw. Inspection of the 
throat shows the characteristic patches of 
the membrane. In some cases these patches 
resemble a thin layer of putty spread over 
the parts. Others present the appearance 
of a very light-yellow paint splashed upon 
the tonsils and adjacent parts. The mem- 
brane may be located in the nose, throat, 
larynx, eye, — in fact, any mucous surface 
may become infected; fresh wounds may 
also become infected. The usual sites, how- 
ever, are the nose, throat, and larynx. 

Transmission. — The disease may be trans- 
mitted by direct contact, by means of con- 
taminated clothing, toys, pictures, books, 
or the germs may be carried on the hands or 
clothing of an attendant. 

Recurrence. — One attack does not protect 
against another. There is evidence that a 
certain degree of immunity is established, but 
it probably is not effective for more than a 
few months. Diphtheria does not run a 
definite course, like the other infectious 
diseases. We cannot say that certain defi- 
nite signs will be present on certain days. 



188 Diphtheria 

It is the most uncertain and treacherous 
disease with which we have to deal. 

Management. — The only treatment of value 
other than supportive measures is the use of 
antitoxin, which must be given early in the 
disease — as soon as a diagnosis of diphtheria 
is made. In fact, I believe it is advisable to 
give it in all cases where there is any un- 
certainty as to whether the case is tonsillitis 
or diphtheria. Much valuable time may be 
lost by delay. The antitoxin should be re- 
peated in from twelve to twenty-four hours if 
improvement does not follow. I have been 
obliged in four cases to give three injections 
of 5000 units each. In one severe case, in- 
jections of 40,000 units were required. In 
the majority of my cases two injections of 
5000 units each were required. 1 No harm 
results from the use of antitoxin. I have 
employed it in a great many cases and have 
lost but two. One child I did not see until 
the fourth day of its illness, which was too 
late for the antitoxin to be of any service. 
The general mortality of diphtheria has been 

1 In the very severe cases in which there is early in- 
volvement of the nose or larynx, from 8000-10,000 units 
should be given at the first injection. 



Chicken- Pox 189 

markedly reduced through its use. During 
convalescence, the child must not be allowed 
to mingle with other children until a bacteri- 
ological examination of the throat shows it 
to be free from diphtheritic germs. 

The instructions for the preparation of 
the sick-room, for disinfection and quaran- 
tine, will be found on pages 193-196. 

CHICKEN-POX 

Chicken-pox is one of the milder con- 
tagious diseases. Among several hundred 
cases I have seen but two that were Severe 
enough to endanger life. 

The period of incubation is quite long, — 
from fourteen to twenty-one days. There 
is slight fever at the onset, rarely high 
enough, however, to be noticed by the 
mother or nurse. More frequently the first 
sign of the disease is the characteristic erup- 
tion, which may appear on any portion of 
the body, the scalp sometimes being particu- 
larly involved. The rash consists of very- 
small blisters which from a distance give to the 
skin the appearance of having been sprinkled 
with water. The fluid soon disappears, 



190 Measles 

leaving a dark-colored crust. When the 
crusts fall, a small scar is often left, which 
may remain for several months. In an 
ordinary case the skin will not be clear 
before the end of the third or fourth week. 

Management. — The child should be kept 
indoors during the attack, and given a re- 
duced diet. The itching is often relieved by 
sponging with a weak solution of alcohol in 
water, — four ounces to a pint, — followed by 
a gentle application of vaseline. 

I never advise quarantine against chicken- 
pox except to avoid needless exposure of very 
young or delicate children in the family. 
The patient should not return to school or 
be allowed to mingle with other children — 
in short, is not to be considered well — until 
the skin is clear. 

MEASLES 

The incubation period of measles — the 
time required between the exposure and the 
development of the first symptom — varies 
between nine and twelve days. One attack 
usually protects against a second. This, 
however, is not invariably the case. 



Measles 191 

The onset of the disease closely resembles 
that of a common cold. The symptoms are 
slight fever, ioo° to 102 F., redness of the 
eyes and intolerance of light, a watery dis- 
charge from the nose, a dry, hard cough, 
pain on swallowing, and loss of appetite. 
The peculiar swollen, congested condition of 
the eyes and face often makes a diagnosis 
possible before the appearance of the rash. 

Rash. — This usually first appears, from the 
second to the fourth day of the illness, upon 
the face and chest. At first there are small, 
irregularly shaped spots said to resemble 
neabites. The spots coalesce, the rash ex- 
tends, and in one or two days the greater 
portion of the skin is involved. The rash 
remains at its height for two or three days, 
when it begins to fade, and in two or three 
days more the skin becomes clear. With the 
subsidence of the rash, desquamation or 
peeling of the skin begins. This consists 
in the shedding of fine, thin scales. The 
fever and prostration keep pace fairly well 
with the rash. 

Fever. — The fever, which may range be- 
tween 102 and 105 F., reaches its highest 
point with the complete development of the 



192 Measles 

rash. With the fading of the rash the fever 
also moderates. 

Cough and bronchitis. — The cough in mea- 
sles is hard and dry in character and is often 
quite severe. It must be remembered that 
the congestion of the respiratory mucous 
membrane which causes the cough is a part 
of the disease. The cough may be relieved, 
but it will not subside until the disease has 
run its course. In many families but little 
attention is paid to measles — it is regarded 
with more or less indifference. While, in 
most instances, the disease may not be par- 
ticularly dangerous, we must remember that 
it is sometimes quite virulent, and domestic 
treatment should never be relied upon. 
There is always more or less bronchitis, 
which in young and delicate infants consti- 
tutes a severe complication, leading, as it 
often does, to catarrhal pneumonia. 

The eyes. — There is always considerable 
involvement of the eyes, the lids being red 
and swollen, with a free secretion of watery 
mucus. 

Management. — The eyes should be washed 
daily with a saturated solution of boracic 
acid. Their sensitive condition requires also 



The Sick-Room 193 

a darkened room, and failure to appreciate 
this fact has often resulted in their permanent 
injury. A darkened room, however, does 
not mean a room devoid of ventilation ; fresh 
air for a patient with a contagious disease is 
almost as important as nourishment. The 
diet must be simple ; only fluid diet should be 
given to ' 'runabouts," while for infants the 
usual milk mixture should be diluted with 
boiled water from one-third to one-half. 
The child should have a lukewarm sponge- 
bath every day, followed by an inunction 
of vaseline, which not only relieves the 
itching, but renders the patient much more 
comfortable. 

Children convalescent from measles should 
not be allowed to go to school or mingle with 
the unprotected until two weeks after the 
completion of desquamation. 

SICK-ROOM FOR CONTAGIOUS 
DISEASES 

QUARANTINE 

A child ill with a contagious disease should 
always be isolated, whether there are un- 
protected children in the family or not. 
13 



194 The Sick-Room 

Quarantine can be carried out only when 
the child is placed in a room alone with the 
nurse or mother, and neither allowed to 
leave the room or in any way to come in 
contact with other members of the family. 
If possible the room should be on the top 
floor of the house. The furniture should be 
of the simplest, — no fancy curtains and no 
upholstery. A perfectly bare floor is best. 
If two nurses are required, two isolating 
rooms will be necessary, one to be used as a 
sleeping-room. The meals should be carried 
on a tray and placed upon a chair outside 
the closed door of the isolating room. The 
dishes containing the food are to be removed 
by the person isolated. After use, before 
returning the dishes to the chair outside the 
door, they should be placed for five minutes 
in boiling water. Only wash goods should 
be worn by the attendants, and their cloth- 
ing, with bed linen when changed, should 
be placed in boiling water — one ounce of 
carbolic acid to two gallons of water — before 
it is sent to the laundry. 

When other members of the family are 
allowed to go at will into and out of the 
isolating room, the value of the quarantine 



The Sick-Room 195 

is practically lost. If the illness is of a 
serious nature, such as scarlet fever or 
diphtheria, the other children of the family 
should be sent to other quarters ; particularly 
should this be done if the family occupy an 
apartment. 

DISINFECTANT DRUGS 

The erroneous views possessed by many 
concerning disinfection often result in much 
harm. Too many are satisfied by the use 
of disinfectant solutions and drugs at the 
expense of cleanliness. Any agent that will 
destroy germs is a disinfectant. Disinfec- 
tion really means cleanliness. Disinfectants 
can never supplant hot water, common 
yellow soap, and a nail-brush. Dipping the 
hands into a solution of carbolic acid or 
bichloride of mercury will not make them 
clean, much less sterile. Sprinkling either 
of these substances upon the floor will not 
clean the floor or be of one particle of service. 
Scrubbing the floor of the sick-room once a 
day, using hot water, sapolio, and a stiff 
brush, will do more to prevent the circu- 
lation of the germ-laden dust than any 



196 Disinfection 

disinfectant which can be used. I recently 
saw a young mother change the baby's 
napkin, immediately after which, with hands 
untouched by soap or water, she very care- 
fully washed out the baby's mouth with the 
boracic acid solution! The young mother 
was anxious to do her full duty by the child, 
but had never learned the rudiments of 
disinfection. 

Disinfectant solutions and drugs are of 
much service when used after a thorough 
scrubbing with hot water, soap, and brush, — 
never before. 

DISINFECTION AFTER CONTAGIOUS 
• DISEASES— FUMIGATION 

Before being allowed to resume his place 
in the family, the child who has recovered 
from a contagious disease should be given 
a tub-bath, with a vigorous scrubbing with 
soap and warm water. The hair should be 
washed with a 1 to 2000 solution of bichlo- 
ride of mercury, and the child dressed in 
fresh clothing outside the sick-room. 

The soiled clothing and the bedding which 
can be washed should be put into a solution 



Fumigation 197 

of one ounce of carbolic acid to two gallons 
of water. The vessel should be covered and 
removed to the laundry and the clothing 
boiled thirty minutes. The bedding and 
such articles as cannot be washed should be 
spread over the furniture in readiness for 
fumigation. 

The windows and doors must be closed 
and sealed, when the room can be fumigated 
with sulphur or formalin. If sulphur is 
used, three pounds of roll sulphur are re- 
quired by the New York Health Department 
for every thousand cubic feet of air space. 
The sulphur is placed in an iron vessel which, 
as a precaution against fire, should stand 
on a large piece of tin or zinc. Alcohol is 
poured over the sulphur and ignited, after 
which the room should not be opened for 
twenty -four hours. If the air in the room 
can be charged with a moderate amount 
of vapor from an open vessel on a stove or 
radiator, the sulphur disinfection will be 
more complete. Formalin acts as a much 
better disinfectant and is far less objec- 
tionable than sulphur. Formalin candles 
for disinfecting purposes mav be found in all 
drug stores. 



198 The Delicate Child 

After the fumigation, the carpet or rugs, 
mattresses and pillows, are taken charge 
of by the health authorities in the larger 
cities, steamed, and returned in two or three 
days free of expense to the owner. Other- 
wise such articles should be sent to the 
cleaner and the mattresses and pillows 
re-covered. The floor of the room and the 
woodwork should be scrubbed with hot 
water, brush, and soap. When dry they 
should be washed with a 1 to 2000 solution 
of bichloride of mercury. The furniture 
should also be washed with the bichloride 
solution. If the walls are papered, they 
should be wiped with cloths moistened with 
this solution; but it is better to have the 
room re-papered. If the walls are painted, 
they should be washed with the solution. 
If the walls can be newly papered, painted, 
or kalsomined, much greater security will 
be enjoyed by the future occupant. 

THE DELICATE CHILD 

In work among children one frequently 
meets with those who, while they cannot 
be said to be suffering from any disease or 



The Delicate Child 199 

pathologic condition, yet are inferior in 
physical development, lack endurance, and 
possess poor resisting powers. They are 
often tinder height, always under weight, 
and, in short, have so many characteristics 
in common that they constitute a class by 
themselves, and as such warrant our attention. 

Normal development. — The average child, 
at the various periods of early life, conforms 
with a certain degree of regularity to the 
mental and physical development which 
by long association we have come to regard 
as normal. Thus a standard may be said 
to have been established, and it is up to 
this standard that we expect the growing 
child to measure. (See pages 9-1 1.) This 
is what we look upon as the average of 
physical and mental development. A few 
children exceed these requirements: they are 
stronger and larger at the sixth month than 
the average child at the ninth month. Again, 
older children at the fourth or fifth year are 
in every way equal to their normal playmates 
a year or two older. 

Abnormal development. — On the other hand, 
there are children who are born with a 
reduced vitality, or who, through faulty 



200 The Delicate Child 

management, usually in relation to feeding, 
acquire a reduced vitality. Semi-invalid 
adults almost invariably beget semi-invalid 
children. If the parents are of average 
health and of good habits, and the debilitated 
condition of the child is due to faulty man- 
agement and nutritional errors, the result 
of proper dietetic and hygienic management 
is usually prompt and satisfactory. With 
the persistently delicate, the offspring of 
physically enfeebled parents, the results are 
less satisfactory, but improvement is always 
possible. 

Management. — By proper regulation of 
the habits of a delicate child, as regards all 
the details of his daily life, a far better adult 
is produced than if no such effort had been 
made. In other words, a diet and general 
regime of life best adapted to the individual 
in question will invariably improve the 
physical condition of that individual. This 
applies to the strong as well as to the deli- 
cate, to the growth and development of the 
young of the lower animals as well as to the 
offspring of man. It is the poorly developed, 
delicate child that we are particularly to 
consider — the undersized, frail, small-boned, 



The Delicate Child 201 

under-weight child, whose appetite is per- 
sistently poor or capricious, who sleeps 
poorly, tires easily, is usually constipated, 
who is subject to catarrhal conditions of 
the respiratory tract, and whose powers 
of resistance generally are diminished. In 
not every delicate child will all these symp- 
toms be found. Under-weight and one or 
more of the other conditions referred to will 
usually be present. 

On assuming the management of one of 
these children it is absolutely necessary to 
make a thorough examination, followed in 
some instances by a few weeks' observation, 
in order to become acquainted with the case 
in its individual aspects, to learn idiosyn- 
crasies, and to eliminate the factor of actual 
disease as a causative agent. When we 
demonstrate to our satisfaction that the 
child is free from such diseases as tubercu- 
losis, kidney disease, and malaria; when we 
have eliminated by properly directed treat- 
ment all causes, such as adenoids, phimosis, 
adherent clitoris, vaginitis, or parasitic and 
irritant skin lesions, which may have had 
a deterrent influence upon growth ; and when 
we have satisfied ourselves as to the actual 



202 The Delicate Child 

condition of our patient, we are in a position 
to lay down definite rules of management. 

Every child has a distinct function to 
perform. As soon as he is born he is con- 
fronted with a serious problem — the problem 
of growth, physical and mental. Inas- 
much as this growth and development depend, 
above all things, upon a properly adapted 
food supply, it must be our first step to 
provide such nutriment as will be most 
conducive to it. As growth takes place 
in all parts of the body through cellular 
activity, the nutritive elements which sup- 
port cell proliferation must be important 
constituents of the diet, and among these 
the proteids are of prime importance; hence 
in the management of these children a point 
to be remembered in the adaptation of the 
food is the necessity of feeding as rich a 
proteid as the child can assimilate. The 
younger the child, the greater the necessity 
for growth. 

Regular weighings necessary. — An infant 
should be weighed at regular intervals, and 
if under one year of age, should not be con- 
sidered as doing even passably well if not 
gaining at least four ounces weekly. When 



The Delicate Child 203 

a baby remains stationary in weight its 
development is invariably abnormal. When 
stationary or when only a slight gain of 
one or two ounces weekly is made, we will 
always find after a few weeks that there is 
malnutrition, in spite of the apparent gain, 
as will be evidenced by the symptoms of 
beginning rickets — anaemia, the character- 
istic bone changes, flabby muscles, and a 
tendency to disease of the mucous mem- 
branes. Delicate infants should be weighed 
daily at first; then, as improvement takes 
place, at intervals of two or more days, but 
never less frequently than once a week, if 
under one year of age, no matter how vig- 
orous they may become. The weighing 
keeps us directly in touch with the child's 
condition, but since the increase may be in 
fat alone, an occasional examination of the 
child stripped is necessary to tell us whether 
there is substantial growth in bone and 
muscle. 

Feeding delicate infants. — When it is de- 
monstrated that a child will not thrive on 
the breast of the mother, another breast 
should be substituted, or an adapted high- 
proteid cow's milk should form the diet in 



204 The Delicate Child 

part or in whole. If the child is bottle-fed 
and it is demonstrated that proper growth 
and development are impossible on cow's 
milk, on account of proteid incapacity, then 
a wet-nurse should be secured. 

When, after the first year, more liberal 
feeding is allowed, the necessity for a high 
proteid in the food selected is as urgent as 
before. This applies to those children who 
are brought to us showing evidences of 
late malnutrition, as well as to those whom 
we have had under our care from early 
infancy. 

An important element in the diet up to the 
third year, is milk. Unfortunately, many 
debilitated children have a very poor capacity 
for fat assimilation. When given full milk 
in as small an amount as one pint daily, 
they often develop foul breath, coated 
tongue, and loss of appetite, or they suffer 
from frequent attacks of acute indigestion. 
The milk is necessary, not because of the 
fat, which can easily be dispensed with, but 
because of the high percentage of proteid 
which it contains — from three to four per 
cent. When this fat incapacity exists, the 
milk is said to " disagree, " but skimmed 



The Delicate Child 205 

milk will be taken without inconvenience. 
Enough sugar may be added to bring the 
percentage up to seven, in order that it 
may replace the fat, for fuel. Skimmed 
milk with sugar added furnishes a food of 
no mean order. Too much milk, however, 
must not be given. When large quantities, 
more than one quart daily, are taken, the 
desire for more substantial nourishment, 
such as eggs, meat, and cereals, is removed. 

At the completion of the first year, keep- 
ing in mind a high proteid, begin with 
scraped beef, at first one teaspoonful once 
a day, in addition to the cereal and milk. 
If this is well borne, and it usually is, a tea- 
spoonful may be given twice a day, and 
later three times a day. It may be given 
immediately before the bottle-feeding. Eggs 
should be brought into use from the twelfth 
to the fifteenth month. At first one-half 
an egg, boiled two minutes, is given mixed 
with bread-crumbs. If well borne, a whole 
egg may be allowed. The cereals used 
should be those most rich in vegetable 
protein, such as oatmeal, containing 16 per 
cent, of proteid, dried peas, 20 per cent, of 
proteid, and dried beans, containing 24 per 



206 The Delicate Child 

cent, of proteid. The peas, beans, and lentils 
should be given in the form of a puree. 

Diet after the first year. — If the child during 
the second year has an indifferent appetite, 
reduce the quantity of milk; never allow 
more than one pint of milk daily for the first 
week or two. Many delicate children who 
apply for treatment after the first year of 
age have been subjected to as grave errors 
in diet as are seen among the bottle-fed. 
Starch foods and milk oftentimes furnish 
the only means of nutrition up to the fourth 
or fifth year, the starch used being generally 
in the form of bread, crackers, and indif- 
ferently cooked cereals. In one case four 
quarts of milk were taken daily by a boy 
of seven years. 

It will be seen that it is our aim in this 
class of children — the delicate, undersized, 
slow-growing class — to give as liberal a 
nitrogenous nourishment as is compatible 
with the digestive capacity of the patient. 
But if the child has had rheumatism, or if 
there is a tendency to lithiasis, the use of 
a large amount of meat is contra-indicated. 
It is in such children that the high-proteid 
cereals are particularly valuable. In a gen- 



The Delicate Child 207 

eral way, from early life the diet of the 
delicate child should consist of milk, suit- 
ably adapted, with highly nitrogenous cereal 
added, when permissible. Many delicate 
children of the " runabout" age who cannot 
digest milk containing 4 per cent, of fat will 
easily digest butter fat when spread on bread 
or potatoes. In this way I often use it 
to supply fuel to act as a proteid-sparer. 
Oat meal- water or oat meal- jelly, mixed with 
the milk, should be ordered at the seventh 
month. When age allows, the addition 
of raw or rare meat, poultry, eggs, and 
purees of dried peas, beans, and lentils 
should be given. Boxed "ready to serve" 
cereals are never given ; raw cereals are used, 
which are cooked three hours. While a 
high-proteid diet is desirable, other things 
are necessary. Green vegetables, animal 
fats, the ordinary cereals, cooked and raw 
fruits, are required to furnish the necessary 
acids and salts, as well as the necessary 
variety. In short, the ideal diet for a deli- 
cate child is that combination of food which, 
while imposing the least burden upon the 
digestive organs, supplies the body with 
material exactly sufficient for its needs, and 



208 The Delicate Child 

such a food must be rich in nitrogen. (See 
dietary, page 71.) 

Baths. — On account of the fear that a 
delicate child may take cold, the bath is 
often omitted. Every child, both the well 
and the delicate, after the second week 
should be tubbed daily. The delicate par- 
ticularly require it. The salt bath (page 
115) is usually advised. The best time for 
giving the bath is at bedtime, and in order 
to avoid all chance of exposure the tempera- 
ture of the room should be elevated to 8o° F. 
The temperature of the water may vary. 
It should never be above 95 F. except for 
very delicate young children in whom there 
is a tendency to a subnormal temperature. 
Even in these cases the temperature of the 
bath should never be higher than the tem- 
perature of the body. In the frail and in 
the very young the bath should not be con- 
tinued over five minutes. In older children, 
those of eighteen months or over, if the phys- 
ical conditions allow, a distinct advantage 
will be gained by a reduction of the tem- 
perature of the bath while the child is in 
the water. An immersion in water at 90 F. 
followed by a gradual reduction during the 



The Delicate Child 209 

space of five or six minutes to 70 F. should, 
upon brisk rubbing, be followed by a quick 
reaction. If the reaction is not good, if the 
extremities are cold and are slow in becoming 
warm, the reduction in the temperature 
should be less or none at all. In the very 
poorly nourished, a reduction below 8o° F. 
should not be attempted. Following the 
drying process, primarily for the benefit of 
the massage, goose oil or olive oil should be 
rubbed into the skin over the entire body 
for from five to ten minutes. The bath 
and the massage inunction, besides favor- 
ably influencing nutrition, are a very effec- 
tive means of inducing sleep. 

Fresh air, — Delicate children are usually 
deprived of a proper amount of fresh air, 
for the same reason that they are insuf- 
ficiently bathed — the fear of making them 
ill. All children need an abundance of 
fresh air, both in illness and in health. The 
robust and the delicate require it, and to 
the delicate it is much more essential than 
to the robust. As many hours daily as 
practicable should be spent out of doors. 
The time thus spent depends upon the 
season of the year and the residence of the 
14 



210 The Delicate Child 

child, whether in the city or the country. 
In the city, during the colder months with 
pleasant weather, the child should spend 
at least five hours daily in the open air, 
dividing the day into two outing periods — 
from 9 to 11.30 in the morning and from 2 
to 4.30 in the afternoon. On very cold 
days, 20 F. or below, on stormy days, and 
on days with very high winds, the child is 
given his airing indoors. He is dressed as 
for out of doors, placed in his carriage, and 
left in a room, the windows on one side of 
the room being open. Not infrequently 
during February and March delicate chil- 
dren will be prevented from going out of 
doors for several consecutive days. If some 
means for a daily systematic indoor airing 
is not provided, these children will often 
go backward, no matter how excellent the 
other management. The first symptoms 
are loss of appetite and the ability to assimi- 
late the food. In my private work among 
marasmus cases, the child is placed in the 
baby-carriage or in a basket and allowed 
to rest before an open window for ten or 
twelve hours of every twenty-four, with a 
hot-water bottle at his feet. Here he is 



The Delicate Child 211 

fed, being removed only temporarily to 
warmer quarters for a change of napkins. 
I have several roof gardens in operation. 
A boy patient nine months of age has been 
in the street only once in four months, then 
only in going to church to be baptized. 

Sleep. — The delicate child requires no 
more sleep than does the strong, and the 
rules governing this matter at the various 
periods of life are the same both for the 
strong and for the weak. (See Sleep, page 
290.) The sleeping-room of the delicate 
child should always communicate with the 
open air by a window, either directly or 
through an adjoining room. A satisfactory 
method of ventilation is by the window- 
board (page 15). The child should occupy 
the room alone, if possible, sharing it neither 
with an adult nor another child. This ap- 
plies to all ages, but is particularly neces- 
sary after the second year. 

The nursery. — The temperature of the 
nursery, day or night, should never be above 
70 F., during the colder months, and in 
the case of the very young, or in those who 
are difficult to keep covered, it should not 
go below 65 F. at night. 



212 The Delicate Child 

Delicate children of the " runabout* * age 
are very susceptible to colds. In the man- 
agement of such children it is necessary to 
use every precaution against exposure. The 
most frequent way of exposing a child to 
cold is by allowing him to sit on the floor. 
To keep the child of from ten months to 
three years of age off the floor during the 
winter months, and thereby to eliminate 
this means of exposure, is a very difficult 
matter. In fact with active children, learn- 
ing to walk, or who have just learned to 
walk, it is practically impossible under the 
usual conditions. During the colder months 
there is always a current of cold air near the 
floor, and allowing the child to creep in win- 
ter, even if the floor is protected by rugs 
and carpets, is one of the surest ways of 
permitting him to take cold. If he is allowed 
to walk on the floor he is soon very sure to 
sit down. If he is not allowed to creep and 
walk about at will, he will not get the proper 
exercise and will show faulty development. 
For such cases I have found the exercise 
pen of immense service (see Fig. 21.). After 
being dressed, washed, and fed, the child is 
placed in the pen, on a rug if desired. Toys 



The Delicate Child 213 

are given him and the door is closed. He 
can now roam about at will, stand up, sit 
down, creep, or walk without the slightest 
danger from drafts. 

Influence of climate, — Much has been writ- 
ten regarding the influence of climate in 
the type of case we are considering. Accord- 
ing to my observation, this matter does not 
deserve the attention it has received. The 
city child in a well-to-do family is, as a rule, 
better off for eight months of the year in his 
own home with its usual conveniences. The 
benefits attributed to change in climate are 
usually the result of a change not of climate 
but to more fresh air, which is afforded by 
the larger rooms of the hotel, with its loosely 
constructed doors and windows; and since 
the parent is desirous that the child shall 
receive the full benefit of the change, he is 
kept in the open air for a much longer time 
than when at home. The air at such a 
place is more expensive, and consequently 
more appreciated than the air at home. 
With sufficient heat and proper ventilation, 
we may make our own climate. It is not 
to be denied, however, that a change of 
residence for a few weeks from New York 



214 The Delicate Child 

to Lake wood or Atlantic City during March 
and April is sometimes of advantage. 

From the first of June to the first of 
October the delicate child should not re- 
main in New York City. The humidity and 
the heat which may prevail for protracted 
periods during this time render it unsafe, 
particularly during July and August. 
The sea shore for the entire summer is 
not to be advised. The children whom 
I have sent inland to the country and to 
the mountains have, as a rule, returned in 
the autumn in a much better physical con- 
dition than those who spent the summer by 
the sea. 

Clothing. — Thin, poorly nourished children 
require more clothing than do those physi- 
cally normal. A fairly good index as to 
whether a child is sufficiently clad is the 
condition of his lower extremities. The 
forearm and hand cannot be relied upon. 
The legs and feet of every child should always 
be warm to the touch. 

As to the nature of the clothing. — A mixture 
of silk and wool next to the skin is most 
desirable. As a second choice a mixture 
of wool and cotton is used. The linen mesh, 



The Delicate Child 215 

often useful in the vigorous "runabout," is 
not to be advised in the delicate. 

Exercise. — Moderate exercise is to be en- 
couraged. But it should never be allowed 
to the point of fatigue. In large cities all 
delicate "runabouts" from three to five 
years of age should be allowed to walk not 
more than six blocks in going to the play- 
grounds. If the distance is greater, the 
child should ride part of the way, play or 
walk for a time, and then be placed in the 
carriage or cart and ride home. Younger 
children, two or three years of age, should 
be wheeled both ways and taken out at the 
park for a run when the weather conditions 
permit. 

Midday nap. — Every day after the midday 
meal the child, regardless of age, whether 
two years or six, should be undressed and 
put to bed for two hours. He should be left 
alone in the room, and whether he sleeps or 
not he should remain in bed for the two hours. 

Entertainment. — Entertaining play is neces- 
sary, but every kind of excitement, such as 
children's parties, emotional plays at the 
theatre, and rough play with older children, 
should be avoided. 



216 The Delicate Child 

Education. — The delicate child under eight 
years of age should be taught only to the 
extent of strict obedience and good habits. 
Other than this he should be a little animal. 
There should be no teaching in the ordinary 
sense of the term, no mental stimulation, 
until the child is physically able to bear it. 
When school- work begins, which in this 
class of children should never be before the 
eighth year, the studies should be made 
easy and the school hours short. Such 
children should never be crowded. I usu- 
ally direct that they attend only the morning 
session. 

The delicate child should be carefully 
watched from the time it comes into our 
hands until it reaches the normal or until 
the period of development is completed. 
While the scheme of management as out- 
lined will not always be attended with 
brilliant results, it will not be in vain. Many 
lives will be saved, and as a result of the 
increased acquired resistance, stronger men 
and women will be added to the race than 
would otherwise have been possible. 



Premature and Weak Infants 217 

PREMATURE AND CONGENITALLY 
WEAK INFANTS 

There are comparatively few infants born 
before the completion of the twenty-eighth 
week of pregnancy that survive the first 
year. Reported cases of survival of those 
born before that time are usually unreliable, 
as they seldom take the child beyond the 
third month. The prognosis is influenced 
by the factors causing the premature birth. 

Management. — In the management of the 
premature and delicate newly born there are 
three points to be considered — the air the 
child gets to breathe, the nourishment, and 
the maintenance of bodily heat. It is also 
to be remembered that we are dealing with 
an undeveloped body which is not ready for 
the environment in which it is placed. The 
premature baby should be handled only when 
necessary, and then in the gentlest manner. 
Bathing is often best omitted for the first 
few weeks, oil being used for cleansing pur- 
poses. Because of the undeveloped paren- 
chyma of the lungs usually good fresh air is 
required. Because of the undeveloped heat- 
centres the body-heat of the premature in- 



218 Premature and Weak Infants 

fants is quickly lost and must be maintained 
by artificial means. The stomach is small 
and the digestive processes are undeveloped 
and weak, so that the nourishment should be 
of the most easily assimilable character. 

Incubators. — The maintenance of heat is of 
the utmost importance. For this purpose 
incubators and their various modifications 
have been used from time to time. My 
experience with incubators has been unsatis- 
factory. They may by careful watching 
maintain an even temperature, but all that 
I have used have been defective in supplying 
fresh air to the child. My incubator babies 
have usually done badly. Removal from the 
incubator was necessary. 

The electrotherm. — If the electrotherm 
(Fig. 12) is not at hand, the padded crib with 
the child wrapped in cotton and surrounded 
by hot-water bottles is the best means of 
maintaining the temperature. A thermome- 
ter should rest between the cotton and the 
bed-clothing as a guide to the nurses in the 
use of the hot-water bottles. Ordinarily 
this should register from 85 to 95 F., de- 
pending upon the temperature of the child, 
whose rectal temperature should at first be 



Premature and Weak Infants 219 

taken frequently. If there is a tendency for 
his temperature to be greatly reduced — 
below 95 F. — more external heat will be 
necessary than if the temperature were 97 or 




FIG. 12. THE ELECTROTHERM 

98° F. The best device among those which 
I have had an opportunity to observe for 
maintaining artificial heat is the electrotherm 
advocated and described by Holt, Diseases of 
Infancy and Childhood, 1906. 

"These small heaters are attached to an 
electric fixture, like a drop-light. A con- 
venient vsize is from ten to fifteen inches. It 
is placed between two or three thicknesses 



220 Premature and Weak Infants 

of blankets, upon which the infant lies in its 
basket or crib. The degree of heat can be 
regulated according to the amount of elec- 
tricity turned on. This mode of handling 
premature infants has been given thorough 
trial at the Babies' Hospital and has been 
found to fulfil the indications, with children 
as small as three pounds and as young as 
seven months, quite as well as the incubator, 
while at the same time being free from its 
dangers. It has not been necessary to raise 
the general temperature of the room. These 
patients when kept in the wards at an ordi- 
nary temperature have maintained an even 
bodily temperature much more uniformly 
than with any other method I have seen, the 
incubator included." 

A mistake often made in the management 
of premature and delicate infants is that of 
providing too warm air for respiration, a 
glaring defect in most incubators. The 
best means of decreasing a delicate child's 
vitality and resistance and increasing his 
chances of pulmonary infection, is to supply 
him constantly with air at 8o° to 90 F. 
In a modern house the maintenance of this 
temperature usually means an absence of 



Premature and Weak Infants 221 

change of air and an abundance of bac- 
teria. The patients do best when the tem- 
perature of the air they breathe is from 70 
to 72 P. 

Necessity of breast-milk. — Breast-milk for 
premature infants born under twenty-eight 
weeks is almost a necessity, and should always 
be procured when possible for all premature 
children. The mother, with the rarest excep- 
tion, is unable to supply it, so that a wet-nurse 
should be secured. In selecting a wet-nurse 
for a premature baby it is advisable to take 
the wet-nurse's baby also, as the premature 
infant may not be able to nurse, or if he 
nurses he will not take all the milk. Pump- 
ing the breasts of a wet-nurse will almost 
invariably dry them up, if her own baby is not 
with her to furnish the necessary stimulation 
of nursing. Sufficient milk may be removed 
by the breast-pump to supply the premature 
infant if he is unable to nurse, and the wet- 
nurse's baby will empty the breast. For 
premature babies who refuse the breast or 
are unable to take a nipple, the Breck feeder 
(Fig. 13) may be used as a means of giving 
nourishment, or gavage, forced feeding with a 
tube, may be brought into use. This I have 



222 Premature and Weak Infants 



been obliged to resort to in several cases. 
The Breck feeder consists of a graduated glass 
tube, narrowed at one end. 
Over this end is placed a small 
rubber nipple, the other end 
being closed by a flexible rubber 
cap. Drawing on the nipple 
is aided and encouraged by 
pressure on the air-filled cap. 
If the breast-milk proves too 
strong it may be diluted with 
equal parts of a 6 per cent, 
sugar solution, from one-half 
to one ounce of the mixture 
being given at first at intervals 
of from one to one and one- 
half hours. Fourteen to fif- 
teen feedings may be given 
in the twenty-four hours, the 
amount depending upon the 
child's digestive ability. 

Feeding other than the breast. 
— If human milk is not ob- 
tainable, whey made from whole 
milk may be given, or one ounce of grav- 
ity cream may be given with one ounce of 
milk-sugar, one ounce of lime-water, and 



fig. 13. THE 

BRECK FEEDER 



Glands 223 

fourteen ounces of water. Canned con- 
densed milk, one part, to from 24 to 30 parts 
of water, may be used with advantage as 
a temporary feeding measure when nothing 
better is available. The food strength is 
increased, the intervals made longer, and 
the feeding larger, as the patient proves able 
to assimilate the food. 

GLANDS 

ACUTE ENLARGEMENT OF THE GLANDS OF 
THE NECK 

A mother is often alarmed by the sudden 
appearance of a hard swelling in the neck 
of one of her children. The swelling may 
appear during the night and increase greatly 
in size for a day or two, when it may be as 
large as a horse-chestnut. Such a condition 
is due to swollen lymphatic glands, which 
are usually situated just behind the jaw and 
below the ear. Occasionally the swellings 
may appear in the soft parts under the jaw. 
The glands, in the performance of their 
functions, have become infected and the 
swelling follows. The cause of the infection 
will usually be found in a lesion of the mouth 



224 Glands 

or throat. It may sometimes be traced to 
a lesion of the skin in the neighborhood of 
the swelling. Thus, the source of infection 
may be a decayed tooth, a simple abrasion 
of the mucous membrane, or an acute inflam- 
mation of the part, such as tonsillitis or 
pharyngitis. In scarlet fever and in diph- 
theria the glands are often seriously involved. 
The glandular enlargements, however, which 
appear suddenly, independent of serious ill- 
ness, need cause no great anxiety. They 
terminate usually in one of two ways: they 
gradually disappear under treatment, or 
they break down and form an abscess which 
requires incision and drainage. In either 
event complete recovery follows. 

If the swellings occur in diphtheria or in 
any other infectious disease, they may con- 
stitute a grave complication. With their 
first appearance, apply cold compresses to 
the parts constantly until the physician 
arrives. 

CHRONIC ENLARGEMENT OF THE GLANDS OF 
THE NECK 

The lymphatic glands of the neck may be 
chronically enlarged as a result of tubercu- 



The Skin in Health 225 

losis, syphilis, or local infections from the 
skin, and a lowered general vitality. 

The mother usually notices a slight swelling 
of the parts, which, upon touch, gives the 
impression of a hard round body immedi- 
ately beneath the skin; usually several 
of these nodules will be discovered. They 
often extend in chains down the side of the 
neck; sometimes both sides will be involved. 
Bunches of glands may also appear under 
the ear and at the angle of the jaw. They 
vary in size from a buckshot to a butternut. 

Children with a tendency to enlargement 
of these glands should be constantly under 
medical supervision. 

THE SKIN IN HEALTH 

The skin of an infant is extremely delicate 
and great care is required to keep it in a 
healthy condition. The secret of a healthy 
skin in an infant is in proper attention. It 
must be kept clean and dry. After the 
daily bath, in which no ingredient other than 
plain boiled water and Castile soap should 
enter, the baby must be carefully dried and 
the folds of the skin and flexures of the joints 
is 



226 Eczema 

thoroughly powdered with equal parts of 
oxide of zinc and powdered starch. When 
the napkins are soiled they should be changed 
at once and the parts again washed and 
powdered. An occasional sponging, fol- 
lowed by a generous use of powder during 
very hot weather, will often prevent annoy- 
ing skin affections, such as prickly heat and 
eczema. 

ECZEMA 

Eczema, a catarrhal inflammation of the 
skin, is a disease to which young children 
are very susceptible. It appears in different 
forms, which means that there are several 
varieties of the disease. Any portion of 
the skin surface may be involved. The parts 
most frequently affected are the scalp, cheeks, 
forehead, and the flexures of the joints, 
where the skin surfaces come in contact. 
The cause of eczema may be from within 
or without. The external causes are all of 
the nature of irritants. A baby's skin is 
very delicate, and trifling causes will often 
produce a great deal of inflammation. Strong 
soaps, liniments, a sudden exposure of the 



Eczema 227 

moist skin to cold air, excessive perspiration, 
insufficient bathing, discharge from the ear 
or nose, all may cause a local irritation and 
produce the disease. Allowing a child to 
rest in a soiled napkin is a most frequent 
cause of eczema of the buttocks, a condition 
which is elsewhere referred to. The treat- 
ment of this type of the disease resolves 
itself into removing the cause and protecting 
the parts by means of a suitable ointment or 
powder. 

Internal causes. — Among the internal 
causes, indigestion is by far the most frequent. 
It is not the delicate child who suffers most 
from eczema. In many instances the robust 
nursling and the vigorous bottle-fed baby are 
the sufferers. The child in other respects 
appears well, has a good appetite, is bright 
and happy, and shows normal development. 
The bright red and sometimes weeping area 
on each cheek, and the itching, scaly forehead, 
show clearly that something is wrong, and the 
error will usually be found in the gastro- 
intestinal tract. The food in some respect 
is unsuitable, not being properly adapted 
to the child's digestive capacity. 

Management in the breast-fed. — In the 



228 Eczema 

breast-fed, regulation of the life of the mother 
as regards her diet, exercise, and bowel 
functions will often effect a cure. 

The bottle-fed. — In the bottle-fed, an ad- 
justment of the food to the child's age and 
digestive capacity and attention to the daily 
bowel evacuation aids materially in the 
treatment. Constipation, if present, must 
be relieved. Local treatment with oint- 
ments, washes, and powders are all of little 
value if the cause of the disorder is not 
removed. The case may improve tem- 
porarily under the local treatment, but within 
a few days the inflammation reappears in 
full force. 

Influence of fat and sugar. — An excess of 
sugar and fat in the diet or an incapacity for 
the substances are very frequent causes of 
eczema in bottle-fed children. 

Eggs and other albumins, both animal and 
vegetable, may cause eczema in susceptible 
subjects. 

The strait-jacket. — One of the difficult 
features of treating children with eczema 
is the tendency for the child to scratch the 
involved parts. This not only keeps up 
the trouble indefinitely but the nails are 



Eczema 



229 



often the carriers of infection. I have seen 
not only severe dermatitis, but furunculosis 




FIG. 14. STRAIT- JACKET 



and cellulitis develop in this way. One of 
the best means of preventing scratching is 
in the modified strait-jacket (see Fig. 14). 




FIG. 15. STRAIT- JACKET IN POSITION 

The jacket is made of muslin and must be 
fitted to the patient. The child is slipped 



230 



Eczema 



into the jacket feet first. The opening A 
encircles the thorax directly under the arms. 
The opening B is closed about the neck with 
the attached tapes. The cord which is used 
to close the end of the sleeves may be tied 
to the sides of the crib or pinned to the bed- 
ding. Children readily accustom themselves 
to the position of lying on the back which 
its use necessitates. It is no kindness to 
allow a child to further irritate the already 
badly involved surfaces. 




FIG. 1 6. MASK PATTERN 



The mask. — In facial eczema, the itching 
is often most intense. In order to effect a 



Eczema 



231 



cure, scratching and rubbing of the parts on 
any object with which the child may come 
in contact, must be prevented. The Thomas 




FIG. 17. MASK IN POSITION 



mask (see Fig. 16) answers this purpose ad- 
mirably. The ointment or lotion is placed 
on clean linen which rests on the involved 
parts. Over this is placed the mask. In 
Fig. 16 is represented a pattern of the mask. 
Opening A is sufficiently large to furnish 
space for the eyes, nose, and mouth. An 



232 Hives 

elastic band which will be seen to pass over 
the upper lip, draws the sides of the opening 
together, insuring protection to the cheeks, 
usually the parts chiefly involved. B and C 
pass over the top of the head and are sewed 
to D and E which pass over the ears, to 
the back of the head where they are united. 
The masks are best made of muslin or thin 
old linen, and are to be renewed daily. 

HIVES 

The type of hives most frequently seen 
in children appears in the form of large 
wheals from one-half to one inch in diameter. 
There may be but two or three of these 
wheals, or a large portion of the body may 
be covered by them. They consist of a 
firm, flat, circumscribed, reddened eruption 
of the skin, without any definite arrange- 
ment. In addition to the skin, the mucous 
membrane of the tongue, mouth, and pharynx 
may be involved. In some instances the 
eruption appears very suddenly, lasts but a 
few hours, and quickly disappears. If the 
attack is of a severe nature new spots appear 
from time to time which behave in the same 



Milk-Crust 233 

way. Hives in children are almost without 
exception due to digestive disorders. I have 
repeatedly known attacks to follow some 
unsuitable article of diet, such as cakes, 
strawberries, pastry, or nuts. Constipation 
may cause an attack. 

The only symptom of consequence is the 
distressing itching which is always present. 

Management. — Treatment consists in the 
use of laxatives and a temporarily restricted 
diet. The itching is best relieved by bathing 
the parts with a solution of carbolic acid — one 
teaspoonful to a pint of water. 

MILK-CRUST 

What is commonly known as milk-crust 
consists of the formation on the scalp of a 
thick layer of yellow sebaceous material. 
In addition to being unsightly it is very 
annoying to the patient on account of the 
itching which it causes. The mother usually 
assures us that the condition is not due to 
neglect. The head is washed and oiled very 
often; but washing will neither cure nor 
prevent the disease. 

Milk-crust is due to an inflammation of 
the sebaceous glands of the skin. 



234 Intertrigo 

Management. — The affection is easily re- 
lieved. The hair must be cut very short, 
and an ointment, composed of resorcin, forty 
grains, and vaseline, two ounces, should be 
spread generously over the diseased area and 
covered with a piece of linen which has been 
saturated with the ointment. Over this a 
fairly tight-fitting, home-made muslin cap 
should be worn to hold the dressing in place. 
The ointment should be applied twice daily. 
After three or four days of the treatment, 
during which time no water must touch the 
scalp, it may be gently cleansed with Castile 
soap and warm water, or with warm sweet 
oil. 

The whole or the greater portion of the 
crusts may be removed with the first washing. 
Some severe cases may require two or three 
repetitions of the treatment. After the 
scalp is clean, an application of the oint- 
ment at bedtime once or twice a week will 
prevent a return of the trouble. 

INTERTRIGO 

Inflammation of the skin of the thighs 
and buttocks, by some mothers erroneously 



Intertrigo 235 

called sprue, is often seen in quite young 
children. In the majority of cases this 
condition is due solely to neglect of the 
toilet. The child is allowed to lie in soiled 
napkins, the irritant discharges thus remain- 
ing in contact with the delicate skin, and 
inflammation and excoriation of the parts 
naturally follow. Children have delicate 
skins and often pass very acid urine. When 
this combination is present an inflammatory 
condition of the parts is frequently difficult 
to avoid. 

Management. — The management is simple, 
usually requiring only a changing of the 
napkin as soon as soiled and the generous 
use of zinc ointment. I have had very little 
success with dusting powders in such cases, 
especially in those of any degree of severity. 
After passage either from the bladder or 
bowels, the napkin should be immediately 
removed, the parts gently washed with 
Castile soap and boiled water, or, in bad 
cases, warm sterilized sweet oil may be used 
to better advantage. After the parts are 
clean, apply to the inflamed area pieces of 
clean old linen which have been covered with 
zinc ointment. If the ointment is applied 



236 Intertrigo 

directly to the skin the napkin soon absorbs 
it, and its application will be of no service. 
The ointment acts as a barrier between the 
irritating passages and the inflamed skin. 
The beneficial effects of the zinc ointment will 
be appreciably increased if white wax (10%) 
is added to it. Under this treatment I have 
repeatedly seen the worst cases of intertrigo 
recover in a week. 

Of course the applications must be repeated 
after each cleansing and drying. The oint- 
ment must be used extravagantly. The dress- 
ing is then applied to the parts and is to 
be changed several times daily. The urine 
which is chiefly at fault, is prevented by the 
ointment dressings from coming in contact 
with the skin, the treatment being solely 
protective. At the same time a quantity of 
absorbent cotton is placed next to the genitals 
so as to absorb the urine as it is passed and 
thus prevent its general distribution over the 
parts. When the case is well advanced 
toward recovery, scrupulous cleanliness and 
a dusting-powder composed of equal parts 
of powdered starch and oxide of zinc will 
usually be all that is required. 



Prickly Heat 237 

PRICKLY HEAT 

In prickly heat there is an acute engorge- 
ment of the vessels of the sweat-glands with 
obstruction to their outlet. Minute papules 
form which are reddish in color. The mild 
cases are without inflammation. When in- 
flammation develops, small vesicles also ap- 
pear and may cover large areas of the body. 
Nearly every infant suffers from prickly heat 
in summer. It is most frequently seen on 
the head and neck and over the chest and 
shoulders. The patients are very uncomfort- 
able and restless. There is evidently a great 
deal of burning and itching. The condition 
is caused by heat, due either to too much 
clothing or to the hot weather of summer; 
both causes may be operative. I have 
frequently seen it in winter in overclad 
children. Most babies are overclad at all 
seasons of the year. When prickly heat de- 
velops, regardless of the season, it is a sure 
sign that the child has been kept too warm. 
The duration is dependent upon climatic con- 
ditions and also upon the treatment. I have 
seen cases which have existed for months. 

Management. — Heavy clothing and flannels 



238 Prickly Heat 

are to be avoided. The clothing should be 
light in weight and of loose texture. In order 
to lessen the local irritation the garment worn 
next to the skin may be lined with silk, linen, 
or gauze. The further means of manage- 
ment as regards both the relief afforded the 
patient and the cure of the condition, con- 
sists in the frequent application of cool water, 
in the form of either a tub-bath or sponging. 
The soda bath, the bran bath, and the starch 
bath (page 116) are all most useful. For 
purposes of sponging, a solution of bicar- 
bonate of soda should be used — one table- 
spoonful to a gallon of water. The relief 
afforded the patient depends not so much 
upon what is used in the water as upon the 
fact that plenty of cool water comes in con- 
tact with the itching, burning skin. Oint- 
ments and salves are of little service here, as 
they tend to produce further maceration of 
the skin. As local applications, powders 
are preferred to lotions. A powder used with 
satisfaction in this condition is of the fol- 
lowing composition: 

$ Boracic acid, 60 grains. 

Powdered starch _ I each I ounce. 

Powdered oxide of zmc> ) 



Fissures of the Anus 239 

This is to be dusted freely over the involved 
surface several times daily, every hour if 
necessary. 

FISSURES OF THE ANUS 

In children suffering from what are called 
fissures of the anus there will be found one 
or more slight tears in the mucous membrane 
just inside the anal aperture. In such cases 
there is always a history of an intestinal 
disorder, usually constipation, sometimes 
diarrhoea, the fissures having been caused 
either by a stretching of the parts by a hard, 
constipated movement, or by the frequent 
irritant passages which have caused a de- 
struction of the mucous membrane of the 
parts. 

An infant thus affected cries lustily when 
having a passage, and strains and presses 
for some time afterward. Very often the 
passage will be streaked with blood. Older 
children postpone going to stool as long as 
possible and complain greatly of pain when 
the bowels move. 

Management. — These cases will be greatly 
relieved by the correction of the intestinal 



240 Boils 

derangement. If the child is constipated, the 
movements should be kept soft by the use of 
suitable diet and laxatives. See page 272. 
If there is diarrhoea, suitable diet and medical 
attention are necessary. The local treat- 
ment, which may be necessary, should be 
carried out by a physician. 

BOILS 

Infants are particularly subject to boils, 
which are supposed by many to indicate 
some radical blood disorder. As a result, 
the victims are drugged and purged with 
all sorts of teas and "blood-purifiers." The 
cause of the boil is very rarely from within. 
It is usually the result of a local infection 
or inoculation into the skin, the germs 
finding entrance by means of a hair follicle 
or an abrasion so small as to be invisible to 
the naked eye. A boil having formed, the 
pus is carried to other portions of the skin 
by the lymphatics, or it escapes upon the 
surface, and, in either case, other portions 
of the skin are inoculated, and a series of 
boils results. The parts most often involved 
are the head, the neck, and the shoulders, 






Head Lice — Pediculi Capitis 241 

although they may appear upon any portion 
of the body, with the exception of the palms 
of the hands and the soles of the feet. I 
have opened one hundred and four on one 
child during a period of three weeks. While 
boils are more frequently met with among 
the debilitated and weakly, they are by no 
means uncommon in the strong and other- 
wise well. 

Management. — Poulticing, and allowing a 
boil to open spontaneously, is calculated to 
prolong the trouble indefinitely. A boil 
should be opened early, the pus evacuated, 
and the surrounding skin thoroughly washed 
with soap and water, when an antiseptic 
dressing composed of several thicknesses of 
old linen, which has been boiled and dried and 
then dipped into a saturated solution of bor- 
acic acid, answers every purpose. Not only 
the boil but the adjacent skin for several 
inches must be covered by the dressing, 
which is to be kept wet with the boracic acid 
solution. 

HEAD LICE— PEDICULI CAPITIS 

Head lice, or pediculi capitis, are very 
frequently seen in out-patient and hospital 
16 



242 Head Lice — Pediculi Capitis 

work among children in all the larger cities. 
Occasionally other children become infected 
in school or in public conveyances and carry 
the vermin to other members of the family. 
Management. — The most successful and 
cleanly treatment consists in cutting the hair 
short ; this done, wash the head with soap and 
water once a day, and after drying moisten 
the scalp thoroughly with the following 
solution twice daily: 

Acetic acid 2 drachms. 

Sulphuric ether 3 ounces. 

Tincture of larkspur, ) , , 

~ . ., . . f y of each 4 ounces. 

Spintus vim rect., ) 

Improvement will follow a few treatments. 
The pediculi will be killed and the nits may 
be removed with a fine-tooth comb. If 
the patient is a girl, it is not absolutely 
necessary to sacrifice the hair. It may be 
parted from various portions of the scalp 
and the solution applied without previous 
washing. However, if the hair is not cut, 
a much longer time will be required to 
effect a cure. 



Fever 243 

FEVER 

By fever we understand an elevation of 
the temperature of the body above the 
normal, which in an infant is 99 F. + by 
rectum. Fever, however, does not con- 
stitute disease. It is nothing more or less 
than a symptom, but it always means that 
something is wrong with the baby. It may 
be due to a slight attack of indigestion, the 
eruption of teeth, or to the beginning of 
scarlet fever, diphtheria, or some other 
disease. Children develop fever much more 
readily than adults, and it is of less signi- 
ficance in them. A child with fever that 
is appreciable to the touch of the mother 
will usually register a temperature of 100.5 
-101.5 F. While such a temperature is 
by no means alarming, its cause should be 
discovered. In the absence of a clinical 
thermometer, in order to examine a baby 
for fever, place upon the abdomen the palm 
of a hand which has been previously warmed. 
Examination of a child's hands, head, and 
feet furnishes us very inexact means of 
judging as to the question of fever. Many 
times these parts will be cold when the 



244 Fever 

thermometer registers a temperature of 104 
or 105 F. Every young mother should 
possess, and know how to use, a clinical 
thermometer. 

Management. — In case of sudden high 
fever — 104 to 105 F. — from any cause, the 
mother cannot make a mistake in giving an 
alcohol and water sponge-bath at a tempera- 
ture of 85 F. One part of alcohol may be 
added to 3 parts of water and the child 
sponged for twenty minutes. If necessary 
the sponging may be repeated every two or 
three hours ; this will keep the child comfort- 
able until the arrival of the physician and 
perhaps prevent unpleasant complications. 
In case of fever the nourishment should 
always be reduced at once ; if the child is on 
the bottle, reduce the strength of the food 
one-half by the addition of boiled water. 
If the child is nursed, reduce the duration 
of each nursing period one-third. Chil- 
dren with fever can always have plenty of 
cold boiled water to drink. Mothers must 
remember that it is not the fever per se, 
but the condition of the patient, which 
governs us in our treatment. In scarlet 
fever and pneumonia, a temperature of 102 






Malaria 245 

to 1 04° F. is expected, and need cause no 
alarm. 

MALARIA 

Children in New York City and vicinity 
occasionally suffer from malarial fever. 
Fewer cases come under my observation 
now than formerly. Malaria is caused by a 
germ, the Plasmodium malaria:.. 

The disease is transmitted by means of a 
mosquito. The mosquito bites an individual 
who has malaria. The mosquito becomes 
infected and infects the next person bitten. 

The fever, languor, and drowsiness will 
appear at a definite time each day, — usually 
from three to five o'clock in the afternoon. 
The child wakes the following morning 
apparently well, but at about the same hour 
in the afternoon the symptoms are repeated. 
There is always a distinct periodicity in the 
symptoms. In some cases the child will be 
ill every second day, but at the same hour. 
In other cases the symptoms are still more 
characteristic and are easily recognized. 
At a certain time every day, or perhaps every 
second or third day, there will be a chill and 



246 Tuberculosis 

a rapid rise in temperature, followed by a 
profuse perspiration, during which the fever 
subsides. 

Management. — The treatment of malaria 
in children is by the use of quinine. The 
majority of the cases recover satisfactorily 
under quinine, but it should never be given 
without a physician's order. The indiscrim- 
inate giving of quinine whenever a child falls 
ill cannot be too strongly condemned. 

TUBERCULOSIS 

Tuberculosis is an infectious disease which 
carries off one-seventh of the population of 
the earth. Children are very susceptible 
to the infection. The disease is caused by 
the entrance into the system of a micro- 
organism known as the tubercle bacillus. 
Tuberculosis is not inherited. The disease 
always comes from without, as does typhoid 
fever or diphtheria. We often see parents 
and children in turn sicken and die with 
this disease. This does not necessarily mean 
heredity, however. It means that there is 
a family condition of constitution which 
furnishes a favorable soil for the develop- 



Tuberculosis 247 

ment of the bacillus. If all who swallowed 
or inhaled the tubercle bacillus became 
tubercular, the earth would be depopulated 
in a very few years. We have all taken the 
tubercle bacillus into our bodies at some 
time, probably many times. In one indi- 
vidual the germ finds a favorable soil and 
flourishes; in another, unfavorable condi- 
tions — health and vigor of constitution, — 
and it dies. The usual means of infection 
is through the inspired air by the inhalation 
of the infected dust from the public convey- 
ances, from the street, or from infected 
dwellings, or in association with people who 
have tuberculosis. Children being very sus- 
ceptible, should never associate with tuber- 
cular adults. Infection may also take place 
by direct contact through kissing. The 
bacillus may be swallowed with food or 
drink which has been contaminated. 

Parts of the body involved. — Almost every 
portion of the body may become the seat 
of the tubercular process. When the micro- 
organism attacks the lungs, it produces 
what is known as consumption, or pulmonary 
tuberculosis. When the covering of the 
brain is involved, the child has tubercular 



248 Tuberculosis 

meningitis. When the hip-joint is attacked, 
hip-disease follows. When the spine is at- 
tacked, it produces what is known as Pott's 
disease. When the glands of the neck 
are infected, scrofulous glands or tuber- 
cular adenitis is the outcome. Tubercular 
disease of the knee is commonly known as 
white swelling. These are the parts which 
are most frequently the seat of the tuber- 
cular process. With less frequency the 
bacillus attacks the bladder, the kidneys, 
the skin, the intestines, the mesenteric glands, 
and the peritoneum. 

General tuberculosis. — In institutions and 
among the poor, what is known as general 
tuberculosis causes the death of many infants. 
At autopsy they show an involvement of 
nearly all the internal organs. Tuberculosis 
in children is always a very serious disease, 
but it is not necessarily fatal; many cases 
recover. When the disease involves the 
spine, hip-joint, or knee-joint, or the glands 
of the neck, the prognosis as regards life is 
usually good. When the brain is attacked, 
it is always fatal. In tubercular disease of 
the lungs in very young children the prog- 
nosis is very grave. Many older children — 



Rickets 249 

those from seven to twelve years of age — 
recover if the disease has not progressed too 
far before coming under treatment. 

Management. — The important features in 
the management of these cases are: com- 
petent medical care, change to a dry climate 
at an elevation of one thousand to fifteen 
hundred feet, with close attention to hygiene 
and a carefully regulated diet in which there 
should be a generous allowance of meat, eggs, 
and milk. 

RICKETS 

Rickets is a constitutional disease due 
to malnutrition. A child with rickets either 
has not received suitable nourishment, or, 
if he has received it, it has not been assimi- 
lated. Lack of nourishment manifests itself 
in characteristic changes in the bones, mus- 
cles, and in the nervous system. In addition 
to their physical characteristics, children 
with this disease may show delayed mental 
development. A rachitic child is usually 
under weight and undersized, particularly 
as regards length. The head is ill-shaped, 
the enlargement of certain bones of the skull 
giving the head a square appearance. The 



250 Rickets 

sutures and fontanelle close very late. I 
have seen the fontanelle still open at the 
fourth year. The teeth are cut late, are apt 
to be soft, and decay early. Many rachitic 
children do not get the first teeth until after 
the twelfth month is passed. The chest is 
narrow and depressed at the sides, and along 
its anterior portion, at the junction of the 
costal cartilages with the ribs, a row of 
nodules can be traced. The ends of the 
long bones, particularly at the wrists and 
ankles, are very much enlarged. In many 
cases this enlargement is so great that it 
produces quite a deformity. Often the legs 
are curved, a condition known as "bow- 
legs." The spine is weak and in severe 
cases the child is unable to sit erect. Spinal 
curvature is frequently seen in these children. 
The abdomen is usually very prominent. 
The malnutrition is further shown by the 
flabby, poorly developed muscles, by the 
tendency to perspiration, particularly about 
the head, and by the unstable nervous sys- 
tem. These children are restless, irritable, 
and hard to please, and they have convul- 
sions under slight provocation. Not all 
rachitic children are below weight; some 



Scurvy 251 

are quite fat, but pale and flabby. The 
changes in the bones, however, are similar 
in both types. In addition to the charac- 
teristics noted, rachitic children possess 
feeble powers of resistance. They are prone 
to catarrhal affections of the respiratory 
and intestinal tracts. In many instances, 
they teeth late and with much difficulty. 
On account of their enfeebled condition and 
lack of resistance, illness in a rachitic child 
is apt to be tedious, if not serious. 

The prevention of rickets depends upon 
proper feeding. Condensed milk used un- 
advisedly and the proprietary meal foods are 
responsible for a large majority of the cases. 

Management. — Proper management re- 
quires suitable food, cleanliness, fresh air, 
and cod-liver oil. By " suitable food" is 
meant good milk for children under one year, 
to which meat and eggs are added as soon 
as they can be digested — usually after the 
twelfth month. For very rachitic children 
I order also one brine bath daily. 

SCURVY 

Scurvy is a disease of quite frequent 
occurrence among bottle-fed children. It 



252 Scurvy 

is characterized by pain in one or more of 
the joints of the long bones, with or without 
swelling of the involved parts and discolored, 
spongy, or bleeding gums. Hemorrhages 
into the skin sometimes occur, which give 
the child a peculiar mottled appearance. 
The disease is often mistaken for rheuma- 
tism because of the swollen and painful 
joints. If the case is a very severe one it 
may resemble paralysis in some of its aspects. 

The disease is due to errors in nutrition. 
The great majority of the cases develop in 
those who are being fed on proprietary meal 
foods, condensed milk, and overcooked cows' 
milk. 

Among the author's cases, one symptom 
was always present: they all showed evi- 
dences of faulty nutrition ; they also presented 
another symptom in common which was the 
earliest active manifestation of the disease, 
and that was pain. The child that has been 
playful, active, and has enjoyed attention, 
suddenly undergoes a change — he prefers 
to rest in the crib or carriage, cries when 
handled, and refuses to play. Often the 
first signs of trouble will be noticed when 
changing the napkin or putting on the shoes 



Scurvy 253 

or stockings. The movement of the diseased 
parts causes pain and the child cries lustily. 
If he is undressed and rests on his back, the 
affected limb in all probability will remain 
motionless, while its companion may be 
moved freely. 

The symptom of pain appears before the 
swelling of the joints, which is sure to follow 
in case the disease is not recognized early 
and treated properly. Another character- 
istic symptom is the swollen, congested, and 
bleeding gums about the upper incisor teeth. 
This condition is sometimes seen early in 
the attack, but it is usually a later symptom. 
Hemorrhages into the skin are of compara- 
tively infrequent occurrence. 

Scurvy uncomplicated is not accompanied 
by fever. Acute articular rheumatism is 
always accompanied by fever. Rheuma- 
tism is rare in children under two years of 
age ; scurvy is rare in children over two years 
of age. There is no excuse for an error in 
diagnosis between the two affections. 

Management. — The treatment is: fresh 
cows' milk, beef juice, and orange juice. For 
a child one year of age the juice of one orange 
should be given daily. Under proper treat- 



254 Rheumatism 

ment the average case will be well in a week or 
ten days, improvement being noticed in 
from twenty-four to forty-eight hours after 
beginning the treatment. 

RHEUMATISM 

Rheumatism is a disease of very grave 
import and of rather frequent occurrence 
among children after the third year. Under 
the second year it is of the rarest occurrence. 
At this age scurvy is frequently diagnosed 
as rheumatism. It may appear in all de- 
grees of severity. The mild attacks are 
often so slight that a physician is not con- 
sulted and the diagnosis of rheumatism 
never made. Such cases are often mistaken 
for sprains and so-called "gro wing-pains.' ' 
Aside from this mild type we have the disease 
in all degrees of severity. The severe artic- 
ular form known as inflammatory rheu- 
matism, is that in which the child, with high 
fever, reddened, swollen joints, dreads your 
approach to the bedside and begs you not 
to touch him. 

The heart in rheumatism. — There can be 
no attack of rheumatism so mild that it 



Grippe 255 

should be ignored. Every child ill with this 
disease is in danger of heart complications 
which may make him an invalid for life. 
Probably nine-tenths of the cases of valvular 
heart disease in adults are due to attacks of 
rheumatism during childhood, and in many 
instances the disease of the heart is not 
recognized until long after the rheumatic 
attack. In every case of rheumatism the 
heart should be examined and properly 
treated. Heart involvement is as liable to 
develop in the mild as in the severe attacks. 
In some cases it is the only evidence of the 
presence of rheumatism. Children of rheu- 
matic parentages and those who show 
rheumatic tendencies should be under the 
constant supervision of a physician. 

GRIPPE 

Grippe is a disease very prevalent among 
children during the colder months. It is due 
to a micro-organism which is usually taken 
into the system with the inspired air. There 
are four types of the disease to be seen in 
children. 

In the most common type the respiratory 



256 Grippe 

passages are the parts chiefly involved. The 
symptoms resemble in some respects those 
of a common cold. There is running at the 
nose, cough, sore throat, and, generally, 
bronchitis. There is a higher fever, how- 
ever, than can be explained by the catarrhal 
symptoms, greater muscular weakness, and 
greater prostration. If uncomplicated, the 
disease usually runs its course in from five 
to eight days. The complications to be es- 
pecially dreaded are bronchitis, pneumonia, 
and otitis. 

The next most frequent type of grippe is 
the muscular. There is fever, headache, loss 
of appetite, prostration, and great muscular 
weakness. There is little or no involvement 
of the respiratory tract. 

The third type includes the cases in which 
the intestinal symptoms predominate. The 
child is taken ill suddenly with fever, pros- 
tration, and diarrhoea which is very hard to 
control. There are from eight to sixteen 
green, watery passages daily, containing a 
moderate amount of mucus, streaked with 
blood. There is also slight cough and coryza, 
with considerable congestion of the throat. 

In the fourth type the nervous system 



Grippe 257 

is chiefly affected. These patients have the 
fever and muscular soreness common to all 
varieties, with the prominent symptom — 
excessive irritability. In some cases there 
seems to be almost entire loss of self-control. 
The patients are peevish, fretful, depressed 
and hysterical by turn. They cannot bear 
the slightest noise, and sleep only when under 
the influence of drugs. 

The severe cases, however, have two 
symptoms common to all — fever and intense 
prostration; prostration and weakness out 
of proportion to all objective symptoms are 
the peculiar characteristics of grippe. I 
have lost two patients aged, respectively, 
three and four months, in both of which the 
system was completely overwhelmed by the 
virulence of the grippe poison. Both chil- 
dren died in less than twenty-four hours, 
apparently from exhaustion. Post-mortem 
examination failed to detect in either case 
any organic change sufficient to cause death. 

A very unpleasant feature of grippe is the 
wretched physical condition in which the 
patient is often left after the acute symptoms 
have disappeared. Weeks of the most care- 
ful treatment will frequently be required 
17 



258 Convulsions 

to restore his previous good health. A 
feature in grippe is the tendency toward a 
slight rise of temperature H to i° F. after the 
child is otherwise well. 

Management. — There is no specific treat- 
ment for this disease. Every case must be 
treated according to the symptoms presented. 
For those which fail to make prompt recovery 
a change of climate should be advised. Many 
of my patients have done surprisingly well at 
Lakewood, or at Atlantic City. 

CONVULSIONS 

A convulsion is a temporary loss of con- 
sciousness, associated with rhythmical con- 
tractions of various muscles of the body. 
Rachitic, delicate children, and those suf- 
fering from malnutrition in any form are 
predisposed to convulsions. Disturbances in 
the gastro-intestinal tract, due to errors in 
feeding, have been the cause in ninety-five 
per cent, of my cases. Nearly all were seen 
among the badly bottle-fed or in those 
beyond the bottle age who had been given 
food unsuited to their years. I have fre- 
quently known seizures to follow an unusual 



I 



Convulsions 259 

indulgence in cake, pie, or fruit. Excessively 
high fever may be a cause of convulsions. 
Pneumonia, meningitis, and contagious dis- 
eases are sometimes ushered in by con- 
vulsions. Heat prostration and worms may 
be mentioned as infrequent causes. A pa- 
tient — a boy three years old — had re- 
peated convulsions until he was relieved 
of forty-three large round worms. Accord- 
ing to my observation, dentition is rarely 
an immediate cause. The dentition period 
covers eighteen months, and children often 
have convulsions during this time ; a thorough 
examination of the patient, however, will 
usually reveal the seat of the trouble in the 
intestinal canal or stomach. Dentition may 
indirectly be a factor. A few years ago a 
mother insisted that I should lance the 
healthy gums of a girl eighteen months of 
age, who repeatedly had convulsions. This 
I refused to do, and ordered, instead, two 
teaspoonfuls of castor-oil. The child passed 
one-quarter of a partially masticated orange 
and the convulsions ceased. 

Management. — When a child is attacked, 
prompt action is necessary. The family 
physician should be sent for and the patient 



260 Convulsions 

placed at once in a mustard bath at a tem- 
perature of 105 F.; an even tablespoonful 
of mustard should be added to five gallons of 
water. The patient should not be allowed 
to remain in the bath over ten minutes, when 
he should be removed and dried vigorously. 
If possible, the child's temperature should be 
taken while in the bath, and if above 102 F. 
(in convulsions it usually ranges between 
104 and 106 F.) the temperature of the 
water should be lowered to 75 or 8o° F. by 
the addition of ice or cold water. Watch 
the effect of the cooling of the bath upon the 
child's temperature, and when it is reduced 
to 101 F. remove him. The temperature 
in convulsions should always be noted. To 
my mind the high fever has oftentimes a 
great deal to do with the seizure. Not long 
since I was called to see a child in convulsions. 
Upon my arrival I learned that he had been 
put into a hot bath at no° F., and kept there 
fifteen minutes, but the child showed no 
signs of improvement. The temperature 
was taken while in the bath, and registered 
111° F., as high as the thermometer would 
register. In this case the hot bath was the 
worst means of treatment that could be 



Colic 261 

devised. There is no advantage in making 
the water hotter than 105 F. In the bath, 
or immediately upon removal, give an enema 
of soap and water so as to insure a movement 
of the bowels as soon as possible. As soon as 
the child can swallow, one or two teaspoon- 
fuls of castor-oil should be given. If it is 
known that the child has taken something 
indigestible, a teaspoonful of syrup of ipecac 
should be given, and repeated in twenty 
minutes if vomiting does not follow. The 
convulsion is very apt to be repeated if the 
cause is not removed. The patient should 
not be held on the lap. He should be placed 
in his crib and kept very quiet. Cold cloths 
should be applied to the head and a hot- 
water bag to the feet. No solid food or 
milk should be given for twenty-four hours; 
broths and barley-water should constitute 
the diet. During the next few days there 
should be no excitement, and the physician's 
orders regarding medication and diet should 
be carefully carried out. 

COLIC 

There are few children who reach the age 
of one year without having suffered from 



262 Colic 

colic. Infants in the earliest months of life 
are particularly susceptible to such attacks. 
The majority of cases are seen in children 
under five months of age, although the seiz- 
ures may continue until a much later period. 
During the attack the child cries violently, 
becomes red in the face, clinches its fists, 
draws up its legs, doubles up its body, and 
straightens out again. The abdomen is 
hard, often distended, and the hands and 
feet are cold. The child rests a few moments 
and cries again. Often all attempts at com- 
forting him fail. An attack may continue 
for a few moments to an hour or more, 
perhaps until the child sleeps from exhaus- 
tion. I have had children brought to me 
for treatment who were so hoarse from crying 
that they could scarcely utter a sound. There 
may be several attacks a day after the feed- 
ings or they may not appear until evening. 
Afternoon or evening colic is probably most 
frequent. These cases are easily explained. 
The overtaxed stomach has done its work 
fairly well early in the day, but as the im- 
proper, frequent feedings follow, it becomes 
tired and refuses to work "overtime." Dur- 
ing the night some rest is obtained, but the 



Colic 263 

following day the entire programme is re- 
peated. So-called colicky children are often 
otherwise perfectly well. If the trouble is 
not particularly severe, they may be well- 
nourished and well-behaved babies when 
not in pain. In the severe cases there is apt 
to be evidence of marked malnutrition. It 
is often remarked that "a baby must do 
just so much crying," and nothing is done 
to relieve it. If one baby cries more than 
another it is because he suffers more. A 
baby rarely cries unless he is uncomfortable 
or in pain. He may cry while his clothing 
is being changed because it disturbs him; 
he will cry from cold, hunger, from the effects 
of a misdirected pin, or from pain of any 
nature, but never without reason. The 
general tendency of the child is to play, to 
smile and be happy. When this is not the 
case something is wrong. 

Cause of colic. — Colic in every instance 
means indigestion. It means that, whether 
breast-fed or bottle-fed, the food is not suit- 
able, — is not adapted to the child's digestive 
powers, or not properly given. The child 
who suffers from habitual colic is usually 
constipated. It has been my experience 



264 Colic 

that the chief error in the diet causing the 
colic was the excess of the proteid — the 
curd-forming element in the milk. It is 
thus practically useless to give carminatives 
and soothing syrups, and other remedies of a 
sedative nature, excepting for the immediate 
effects. 

General management. — Whatever error may 
exist in the feeding must be corrected. If 
the patient is a breast-baby we must treat 
the mother — the source of the child's nour- 
ishment. Nursing mothers of colicky babies 
are usually of sedentary habits, hearty eaters, 
and constipated. Our first step must be 
to cure the constipation of the mother. She 
should have one full, free passage from the 
bowels daily. She should exercise in mod- 
eration in the open air: a walk of an hour 
or two in the morning, and an hour in the 
afternoon, will be most beneficial. Her diet 
should consist of fresh meat, poultry, fish, 
cereals, soups, baked potato, green vege- 
tables, and stewed fruit. Coffee may be 
taken in moderation; milk, cocoa, chocolate, 
and water may be taken freely. A nursing 
mother should drink no tea. It is a popular 
idea that tea is a very necessary article for 



Colic 265 

the nursing mother. Hardly a week passes 
but I hear from the out-patient mother of 
a sick breast -baby that she is drinking from 
one to two gallons of tea a day. The tea is 
kept "on the back of the stove, " so as to be 
ready for use at any time. I have relieved 
many cases of colic in the child simply by 
curing the mother's constipation and regu- 
lating her diet. 

Menstruation often causes temporary at- 
tacks of colic and other digestive disturb- 
ances in the child. Fright, anger, worry, 
or anything in the nature of a shock in the 
mother will often seriously affect the child's 
digestion. In short, when the nursing child 
suffers thus from digestive derangements, 
the error, nine times out of ten, rests with 
the mother. The trouble is rarely with the 
child. 

As previously stated, habitual colic in 
the bottle-fed tells us that we are not giving 
the child a suitable food, or that we are 
not giving a suitable food properly. The 
food as a whole may be too strong or too 
weak. It may be given too frequently. 
If cows' milk is the diet, the error is often 
due to improper modification. The proteid 



266 Colic 

will usually be found in excess ; not in excess, 
perhaps, for the average child, but in excess 
for the patient in question. There can be 
no set rules for feeding or definite formulae 
for various ages that are infallible. The 
food of artificially fed children must be 
adapted to meet their individual require- 
ments. The treatment of habitual colic in 
the bottle-fed consists in rendering the food 
suitable. 

Management of acute attacks. — For the 
relief of immediate attacks, an injection of 
from six to eight ounces of water at no° 
F., to which one-half teaspoonful of salt 
has been added, will often be of service. 
Five to eight drops of gin in a teaspoonful of 
warm water, by mouth, is sometimes useful. 
Two-drop doses of Hoffmann's Anodyne in 
two teaspoonfuls of hot water will frequently 
cut short a severe attack. Both the gin and 
the anodyne may be repeated in one-half 
hour if relief is not obtained. If the attack 
is prolonged, a hot-water bag should be 
placed at the feet, and flannels wrung out of 
hot water applied to the abdomen. Often- 
times, in order that the digestive organs may 
have a complete rest, it is advisable to dis- 



Constipation 267 

continue the regular food for a few hours 
and give barley-water as a substitute. 

CONSTIPATION 

Among the derangements of the young, 
there are few which give more annoyance 
or are harder to manage successfully than 
constipation. The causes of the trouble are 
anatomical and dietetic. The comparatively 
long large intestine folded upon itself in 
the narrow pelvis offers an obstruction to the 
free passage of the intestinal contents. The 
lack of development of the muscular struc- 
ture of the intestine is also a cause. Deficient 
nerve power, due to lack of development of 
the sympathetic nervous system, is thought 
by many to be an important factor. In all 
probability all these agents may be regarded 
as predisposing causes of constipation. The 
chief cause of constipation, however, accord- 
ing to my observation, is the proteid (the 
curd) in the child's milk. When the amount 
of proteid is excessive — a higher percentage 
than normal — the child will be constipated. 
A child fed on a normal proteid with a low 
fat may also probably become constipated. 



268 Constipation 

Management in the breast-fed. — Among the 
breast-fed, the dietetic management of this 
disorder is difficult, for it is hard to change 
the character of the mother's milk. Much 
may be done, however. Inquiry into the 
daily life of the mother will usually disclose 
sedentary habits, a good appetite, a fond- 
ness for tea, and, probably, constipation. An 
examination of the milk of these mothers 
will show that the normal proportions of 
fat, proteid, and sugar are not maintained. 
The percentage of proteid is usually found 
to be higher than normal, with low or normal 
fat. 

The first step in the treatment is the regu- 
lation of the habits of the mother. The 
bowels should be evacuated daily, with a 
laxative, if necessary. She should be placed 
on a diet of fresh meat, fresh vegetables, and 
fruit. A malt liquor with luncheon or dinner 
is also sometimes recommended. She is 
instructed to take at least three hours* exer- 
cise daily in the open air. This regime will 
diminish the proteid and increase the fat in 
her milk, and not only relieve constipation 
in the child, but insure better nourishment 
and a later weaning than would otherwise 



Constipation 269 

be possible. The treatment of the mother is 
all that is necessary in a considerable num- 
ber of cases, but when this fails, the child 
demands attention. 

In treating the child my first step is to 
give cream; not cream purchased as such, 
but cream which rises upon the best milk 
obtainable. I give from one-half to two 
teaspoonfuls in quite w T arm water immedi- 
ately before nursing. The use of the gluten 
suppository at the same hour for several 
consecutive days will do much to establish 
the habit of a passage at a regular hour each 
day. 

In case the cream does not agree with the 
child or is ineffective, pure cod-liver oil — 
fifteen to thirty drops three or four times 
a day, or one teaspoonful of sweet oil two 
or three times a day — may prove beneficial. 
When these measures fail, as they will in a 
small number of cases, liquid alboline (aro- 
matic), so-called mineral oil, may be used, 
two to four teaspoonfuls daily. 

Management in the bottle-fed. — The treat- 
ment of bottle-fed and "runabout" children 
is much easier and the results more satis- 
factory. It is, moreover, very simple, and 



270 Constipation 

resolves itself largely into a manipulation 
of the fat and the proteid. Given a bottle- 
fed child, six months of age, suffering from 
obstinate constipation, the proteid should 
at once be cut down to a minimum by pre- 
scribing a cream, water, and sugar mixture. 
This should be given raw, if practicable. 
A 16-per-cent. cream is desired. Allow the 
milk which is delivered in bottles at about 
six o'clock in the morning to remain in 
the refrigerator until noon, when all the 
cream is removed. If the milk is good, the 
cream will contain approximately 16 per 
cent, of fat; if it deviates from this figure, 
the percentage will probably be lower. I 
use the pint (sixteen ounces) for a standard. 
If we mix one ounce of this 16-per-cent. 
cream with fifteen ounces of water, we will 
have a i-per-cent. fat mixture. If two ounces 
of cream are mixed with fourteen ounces of 
water, a 2-per-cent. fat mixture will result; 
if four ounces of cream with twelve ounces 
of water, we will have a 4-per-cent. fat mix- 
ture. But our 16-per-cent. cream contains 
more than fat. It contains also, approxi- 
mately, 3.2 per cent, proteid and 3.2 per cent, 
sugar. If, then, we are to prepare a food 



Constipation 271 

for this six months' constipated baby, we 
need a high fat mixture — four per cent. — 
with a low proteid. In order to obtain it, 
we use four ounces of cream and twelve 
ounces of water. This, as will easily be 
seen, will furnish us a 4-per-cent. fat, .8-per- 
cent, proteid, and 8-tenths-per-cent. sugar. 
The fat is as high as we wish it, the proteid 
low where it ought to be, but the sugar is 
too low, and this we increase by the addition 
of milk-sugar or cane-sugar. 

A word about the low proteid — .8 of one 
per cent. Compared with the mother's milk 
it is low, but we must remember that in 
our modifications we are not dealing with 
mothers' milk. In many cases it is unwise 
to attempt to give as high a proteid as that 
contained in mothers' milk, for the reason 
that it is more difficult of digestion, and, 
by reason of its higher nutritive properties, 
it is not required. In case the reduction 
of the proteid is impracticable, or does not 
furnish relief, I add to each feeding of the 
cream or milk mixture one or two teaspoon- 
fuls of Mellin's food or malted milk, which 
will often act as a satisfactory laxative. 
One feeding daily of malted milk, which 



272 Constipation 

replaces the customary feeding, is another 
means of relieving constipation in the bottle- 
fed. In older children — eight to twelve 
months of age, — cream diluted with water 
is often given with oatmeal jelly, — one or 
two tablespoonfuls to each feeding. It is 
extremely rare for a case to resist this treat- 
ment, and when it happens I usually find 
the stool soft when voided, deficient peri- 
stalsis being, doubtless, the cause of con- 
stipation. In such cases medication is 
required. The sweet oil or the liquid alboline 
(aromatic) as advised for the breast-fed may 
also be used here. 

Management in older children. — In "run- 
about" children the use of cream and water 
mixtures, rare meat, green vegetables, stewed 
and raw fruit, renders the management of 
constipation exceedingly simple. The meals 
must be given at regular intervals, and 
crackers and white bread excluded. The 
Bennett's wheats worth biscuit and whole 
wheaten bread may be used with advantage. 
Fruits are best given between meals. The 
juice of two oranges may be given at II A.M. 
and apples, pears, grapes, or peaches at 4 P.M. 

It is our hope in treating constipation to 



Constipation 273 

relieve the patient by the dietetic measures 
above suggested. When these fail, we must 
resort to other means. Enemas and sup- 
positories may be used occasionally, but 
the child should not become accustomed to 
them. In the severe cases which resist die- 
tetic treatment, the outlook for an early 
recovery is not promising. In such cases 
the use of an enema of olive oil at bedtime 
has proven very satisfactory. A small 
amount of the oil, two to three ounces, is 
introduced through a large catheter, No. 18 
American (male), which is inserted ten or 
twelve inches, the catheter being attached 
to a bulb syringe with a capacity of six ounces 
(see Fig. 18). An evacuation is not desired 
until the following morning, when the child 
is placed at stool after his breakfast and 
allowed to remain fifteen minutes. If no 
evacuation occurs at the end of this time, a 
slight stimulation in the use of a suppository 
or soap-suds may be used to bring it about. 
In a comparatively few days usually the 
morning evacuation takes place without 
assistance. The oil should be continued 
for several days, when it may be omitted 
one night in seven. When an evacuation 
18 



274 Vaccination 

follows the next morning, it may be omitted 
one night in five. In this way the oil 
may be gradually lessened until it is no 
longer required. In some children a small 




FIG. 1 8. THE BULB SYRINGE 

amount of the oil will be passed during 
the night. These should wear a napkin. At 
this age also the liquid alboline (aromatic) 
may be used in dosage of one to two table- 
spoonfuls at bedtime. 

VACCINATION 

Every baby in fair health should be vac- 
cinated not later than the third month — 



Vaccination 275 

before any trouble incident to dentition 
may arise ; for the younger the child, the less 
the constitutional disturbance. Vaccina- 
tion in a child two to three months of age 
causes practically no illness whatever. Both 
sexes should be vaccinated on the outer 
side of the calf of the leg: girls, because the 
resulting scar on the arm may be regarded, 
in later life, as a disfigurement; and both 
boys and girls, because when the sore is on 
the leg it is more easily cared for. In dress- 
ing and undressing a child, the arm has to be 
manipulated to a considerable extent, thus 
causing more or less discomfort. 

Management of the wound. — The wound 
should be kept covered with a sterilized gauze 
bandage until the crust falls, leaving the dry 
pink skin underneath. Tub bathing should 
be discontinued until this takes place. 

Vaccination shields are all worse than 
useless; they are often positively harmful, 
for they usually become displaced and may 
irritate and infect the sore. When unpleas- 
ant results follow the vaccination, the virus 
is rarely at fault. The infection is usually 
due to carelessness or to uncleanliness in 
the treatment of the wound. 



276 Vaccination 

Necessity of vaccination. — Vaccination will 
always be considered by people who enjoy 
the possession of an ordinary amount of 
knowledge and a moderate amount of com- 
mon-sense as one of the greatest discoveries 
of medical science. Since its discovery by 
Jenner, as statistics show, millions of lives 
have been saved by vaccination. It would 
seem strange that one should feel it necessary 
to speak in defence of a measure which has 
been of such incalculable value to the human 
race, but there are a noisy lot of mentally 
incompetent ant i- vaccinationists, who are 
not without influence among their kind and 
the otherwise ignorant, upon whom the 
following statistics by Allen (Pediatrics, 
February, 1900) would produce no effect : 

In 1 87 1, Germany lost one hundred and 
forty-three thousand lives by smallpox; in 
1874, a law was enacted making vaccination 
obligatory during the first year of life and 
compelling its repetition during the tenth 
year. The result was that the disease almost 
entirely disappeared. At the present time 
the loss of life from this disease throughout 
the empire is scarcely one hundred a year. 
At the time of the Franco- Prussian War, 



Bed-Wetting 277 

the entire German Army was re-vaccinated; 
while in the French Army, vaccination being 
optional, comparatively few were vaccinated. 
Both armies were attacked by smallpox, the 
French losing twenty-three thousand men, 
the German, two hundred and seventy-eight. 
With such statistics how can there be any 
plausibility in the argument of the anti- 
vaccinationists ? 

BED-WETTING 

The urine is voided involuntarily by most 
children until well into the second year. If 
the child is carefully trained, the function 
of urination may be under perfect control 
during the waking hours by the end of the 
first year. We hear now and then of a child 
who urinates voluntarily at the age of six 
months. Such children are rare. The urine 
is passed normally during sleep until the 
child is two and one-half or three years of 
age. In many this will be controlled at the 
end of the second year, but I do not regard 
the lack of control as an abnormality until 
the third year is reached. If the urine is 
passed involuntarily after the child is three 



278 Bed-Wetting 

years old, a physician should be consulted, 
not necessarily to give drugs, but to instruct 
the mother as to the diet and general hygiene. 
Causes of bed-wetting. — Incontinence of 
urine may be due to a great varietyof causes, 
among which may be mentioned a highly acid 
urine, stone in the bladder, which is of 
comparatively rare occurrence, adenoids, 
thread- worms, constipation, inflammation of 
the vulva and vagina in girls, and tightly 
adherent foreskin in boys. By far the 
greatest number of cases, however, are due 
to a lack of development of the nervous 
system and, in addition, a bad habit. Not 
infrequently the trouble is caused by too 
freely indulging in water and milk late in the 
afternoon and during the night. It is rarely 
a symptom of kidney or bladder disease. 
The relief of the inveterate bed-wetter of 
five or six years of age is often most difficult. 
The child must be examined by a physician 
to determine that there is no local cause for 
the trouble. If no such cause is found, well- 
directed medication, with the mother's co- 
operation, will usually relieve the patient, 
although it may require months to do it. In 
the cases of only occasional bed-wetting, 






Bed-Wetting 279 

and with younger patients, the mother alone 
can often accomplish considerable. 

Management. — No water or milk should 
be given after four o'clock p.m. The child 
should have a dry supper, for which I would 
suggest farina, hominy, or rice, any of which 
may be served with butter and a little sugar. 
If the child will not take the cereals without 
milk, a very little may be added. This with 
stewed fruit and a piece of bread is sufficient. 
The child's bedclothing should be light, and 
he should be made to sleep on his side, not 
on his back. In order to prevent the child 
resting on his back, tie a piece of any thin 
goods about the body, with a large knot 
between the shoulders. The child should 
always be taken up at ten or eleven o'clock 
and made to urinate. 

If there is phimosis, vaginitis, thread- 
worms, or any local disorders, treatment 
of the local conditions may effect a cure. 

Incontinence during the day. — A few bed- 
wetting children are troubled with inconti- 
nence during the day as well. There is a 
constant leakage, the clothing being wet the 
greater part of the time. The management 
of these cases, however, differs in no respect 



280 Care of the Genitals 

from that advised for those first mentioned, 
except in the matter of medication, which 
can be carried out only by a physician. 

CARE OF THE GENITALS 

PAINFUL MICTURITION, CIRCUMCISION 

In girls very little care of the genitals is 
required other than cleanliness. The parts 
should be washed in boiled water and Castile 
soap once a day. Sponges should not be 
used. Soft old linen is far better, and after 
once using it should be burned. A sponge 
is never clean after it has once been used, 
and should have no place in the nursery 
outfit. After cleansing, the parts should be 
dusted thoroughly with the following powder : 
boracic acid ten grains, powdered starch and 
oxide of zinc each one-half ounce. 

With boys more attention is required. 
The normal condition, a free foreskin, non- 
adherent to the glans penis, is necessary 
for his comfort and health. It should be 
stripped back once a day and the parts 
washed very gently with Castile soap and 
warm water, dried with absorbent cotton, 



Care of the Genitals 281 

and a bit of vaseline applied. In the ma- 
jority of boys the foreskin at birth is tightly 
adherent to the glans, with only a pin-hole 
opening. Such a condition is one of much 
annoyance to the child. Secretions which 
act as a foreign body form under the foreskin, 
producing no little irritation, drawing the 
child's attention to the parts, and thus often 
leading directly to the habit of masturbation. 
Inflammation of the foreskin and urethra 
not infrequently follows this condition. As 
a result, urination is painful and the urine 
is retained until the child cannot pass it. 
I have known children for this reason to 
hold their urine for over twenty-four hours. 
I have known pus to form under the foreskin, 
necessitating immediate operation. In two 
boys aged about two years, repeated convul- 
sions occurred, for which no reason could be 
assigned other than the irritation caused 
by the tightly adherent foreskin and the 
retained secretions. They were circum- 
cised, and have been perfectly well since. 
Bed- wetting is often a direct outcome of this 
trouble. 

Necessity of circumcision. — Four out of 
five of the boys who come under my care 



282 Retention of Urine 

need circumcision. This does not mean that 
four out of five are circumcised, as family 
objections are often hard to overcome, even 
where the physician is convinced that such 
a measure would be beneficial. In a very 
few cases, stretching and retracting the fore- 
skin may answer every purpose. But such 
cases are rarely properly attended to after- 
ward ; no matter how careful the instructions 
given, the adhesions are allowed to re-form, 
and in a short time all the annoying symp- 
toms return. The daily manipulation of the 
parts necessary for cleanliness is for obvious 
reasons to be avoided if possible. When a 
child is properly circumcised he is relieved 
for all time. 

RETENTION OF URINE 

This condition often greatly alarms 
mothers. In girls, the most frequent cause 
is pain due to the inflammation of the ure- 
thral orifice and the adjoining parts, which 
may have been caused either by excessive 
acidity of the urine, or by vaginitis. Re- 
tention sometimes results from taking cold; 
high fever is sometimes a cause, and, in 
some instances, no cause can be discovered. 



Retention of Urine 283 

In boys the retention may be due to ure- 
thral irritation produced by excessive acidity 
of the urine; far more frequently, however, 
the trouble is caused by an inflammation 
of the foreskin, which is often swollen to 
three or four times its normal size. In these 
cases the orifice of the urethra will usually 
be found red and swollen. In either sex, 
if there is retention of the urine for over 
sixteen hours, place the child in a tub of 
warm water at a temperature of no° F., 
and often urination will follow immediately. 
Another useful method of treatment con- 
sists in the application to the parts of cloths 
wrung out of hot water. Perhaps the best 
results are obtained by the use of an enema 
of a normal salt solution — a teaspoonful of 
salt to a pint of water — at a temperature 
of 110 F. ; at least a pint should be used for 
this purpose and the child allowed to retain 
it if he will. This treatment rarely fails. 
If it does, the doctor must use the catheter. 
The swelling of the parts in boys is best 
reduced by a wet dressing of a saturated 
solution of boracic acid, which is applied 
on old linen wrapped around the parts and 
changed every half -hour. In girls a simple 



284 Worms 

pad composed of several layers of old linen 
should be saturated with the boracic acid 
solution and similarly applied, the dressing 
being changed every hour, and the parts 
gently bathed with the solution. 

WORMS 

There are three varieties of worms com- 
monly met with in children: the round- 
worm, the thread- worm, and the tape- worm. 

Round-worms occur most frequently in 
children from two to ten years of age, 
although no age is exempt. When a child 
picks its nose, grinds its teeth at night, sleeps 
poorly, has a coated tongue, and an indiffer- 
ent appetite, it is supposed by the older 
members of the family to have "worms." 
These symptoms may indicate the round- 
worms, but they far more frequently indicate 
a too close acquaintance with gingerbread 
and jam and other cupboard, between-meal 
indulgences. Frequent attacks of colic, con- 
stipation, alternating with diarrhoea, and 
convulsions are, in my judgment, the most 
reliable symptoms of round- worms. The 
only positive means of diagnosis, however, 
is the discovery of the worm itself, or the 



Worms 285 

presence of the eggs in the stools. The 
round-worm resembles the common earth- 
worm. It is usually from five to nine inches 
in length and inhabits the small intestine. 
Round-worms are seldom seen among city 
children ; in the country, however, they occur 
with much greater frequency. 

Thread-worms inhabit the lower portion of 
the large intestine, and in appearance are 
like pieces of white thread. They are usually 
from one-quarter to one-half inch in length. 
They are very frequently seen among the 
children of the tenements. Occasionally 
they occur in children of the better classes. 

The chief symptom of these worms is an 
itching or irritation about the anus. The 
child is restless and sleeps poorly. In girls 
there may be a vaginal discharge due to the 
irritation caused by the worms, which have 
migrated to these parts. Frequently the 
only symptoms of discomfort will be mani- 
fested when the child is put to bed. He 
will then complain of a biting, burning 
sensation in the rectum. In some, the 
rectal irritation is so great as to cause very 
pronounced nervous symptoms. 

Several years ago I treated a six-year- 



286 Worms 

old girl for involuntary movement of the 
arm and shoulders somewhat resembling 
St. Vitus's dance. The trouble disappeared 
after several weeks' treatment for the thread- 
worms which were present in large numbers. 
I have seen many cases of prolapse of the 
bowel due to the straining which was caused 
by the irritant action of the worms. In both 
sexes they may be a cause of bed-wetting 
and in girls are not an infrequent cause of 
masturbation. In some instances after treat- 
ment the worms will be passed in great 
numbers in the stools, and may sometimes 
be seen adhering to the skin of the parts. 

Tape-worms in children are very rarely 
seen in this country. I have seen but eight 
cases among many thousands of children 
treated during the past seventeen years. 
The presence of the tape-worm is indi- 
cated by various indefinite manifestations. 
Constipation alternating with diarrhoea are 
prominent symptoms. The child is often 
ravenously hungry. A positive diagnosis 
can be made only after the discharge of 
segments of the worm, which appear like 
short pieces of narrow white tape linked 
together. 



Excitement 287 

The diagnosis and treatment of worms 
in the children of the household appear to 
be a jealously guarded function of the good 
grandmother. Young mothers, however, will 
do well to have the family physician usurp 
this prerogative. 

EXCITEMENT 

A baby should not be subjected to excite- 
ment or its equivalent — too active entertain- 
ment. The nervous system of an infant is 
in such an undeveloped state that what 
would be a decided tax upon it cannot be 
appreciated by adults, who are often appar- 
ently insensible of the fact that children are 
different from themselves. 

The first child in a well-to-do family is 
usually the greatest sufferer from superfluous 
attention, — being a source of unending ad- 
miration on the part of the family and friends. 
He is often present very early in life at all 
important functions. Christmas, Thanks- 
giving, birthday celebrations, and afternoon 
teas find him the centre of attraction. He 
is handed from one guest to another and is 
tossed upon various angular knees. He 



288 Kissing 

is kissed by lips which dare touch only 
those who cannot protect themselves. He is 
talked to with a very loud voice in a very 
silly manner and grimaces horrible to witness 
are made at him. I have witnessed such 
scenes, and have treated exhausted infants 
who required medical attention after the 
seance was over. I have, indeed, seen in- 
fants thus brought to the verge of collapse. 
One child of eleven months had convulsions 
which were indirectly due to fatigue incident 
to a Thanksgiving celebration. 

KISSING 

Such a topic is not to be considered out 
of place in a work of this nature; in taking 
up the child's management in all its details, 
it is my belief that a few remarks on this 
subject are perfectly in order. Every detail 
of the child's daily life should be under the 
oversight of the physician, and if he is to do 
his full duty, he must give a certain amount 
of voluntary, unsought advice. A custom 
concerning which he will not be consulted 
is the matter of that most unhygienic practice 
of kissing. 



Kissing 289 

A child should never be kissed on the 
mouth, and this is a standing order with all 
my patients. I have known, in my own 
private practice, of instances where tuber- 
culosis, diphtheria, and syphilis have been 
communicated from the diseased adult to 
the innocent child by this disgusting prac- 
tice. Neither should the child's hands or 
fingers be kissed, as the hands and fingers 
of the majority of babies are in their mouths 
many times an hour. If baby is the first 
one that has graced the household, and must 
be kissed, this can be accomplished with the 
least damage if the kiss is implanted on 
the head or forehead. The parents must 
make the rule, and they must set the exam- 
ple by adhering to it themselves. 

Among my patients, a nurse who is known 
to have kissed the child is punished by dis- 
missal. Because an adult is apparently well 
is no excuse for this indulgence. Healthy 
adults frequently have in their mouths the 
germs of tuberculosis, of diphtheria, and of 
other diseases, and never suffer from their 
presence because they are strong adults with 
vigorous mucous membranes which do not 
furnish as favorable a soil for the growth 
19 



290 Sleep 

and development of pathogenic bacteria as 
do the more delicate mucous membranes 
of the young. It is criminal, therefore, to 
subject the child to such dangers. Scarlet 
fever, measles, and whooping-cough are all 
most readily transmitted at the beginning 
of an attack through the close contact re- 
quired by a kiss. 

Kissing should not be allowed among 
children. Little girls are very prone to 
follow the customs of their mothers, whether 
good or bad; hence, the necessity of advice 
in this direction will be impressed upon the 
parents if they will observe the interchange 
of bacteria which takes place on the sailing 
or arrival of any of our large ocean steamers ! 

SLEEP 

The infant that sleeps well is almost always 
a normal, well-fed baby. Irritability and 
sleeplessness are associated with indigestion 
more frequently than with any other disorder. 
During the first few days of life the sleep, 
in normal conditions, is almost unbroken, 
except when the infant is fed. During the 
first month the infant sleeps about twenty- 



Sleep 291 

two hours out of every twenty-four; during 
the second and third months, from twenty to 
twenty-two hours. At the sixth month the 
child should sleep from 6 p.m. to 6 a.m. 
without interruption other than for feeding 
or nursing, which need cause very little dis- 
turbance. At this age there should be a 
two-hour nap during the morning and a two- 
hour nap in the afternoon, although it is not 
well to have the baby sleep after three o'clock 
in the afternoon. The twelve-hour night rest 
should be continued until the child is six 
years of age. The day naps will gradually 
be shortened by the child. At one year of 
age, one hour in the morning and two hours in 
the afternoon suffice. From the eighteenth 
month to the second year, the morning nap 
is given up. Afternoon rest for at least one 
and one-half hours should be continued until 
the child is six years of age, and longer if he 
is inclined to be delicate. Regular sleep is 
largely a matter of habit, and if the infant is 
started right, with suitable feedings given at 
definite times, followed by the proper period 
of sleep, but little trouble will be experienced 
with sleeplessness. When sleep is disturbed 
and broken, it means bad habits, unsuitable 



292 Crying 

food, minor forms of indigestion, or positive 
illness of some kind. Sleep is important for 
purposes of growth not only in early infancy 
but throughout childhood. Not a few infants 
form habits of sleeping in the daytime and 
being wakeful at night. This is best remedied 
by keeping the baby awake when he should 
be, during the day, by entertainment and by 
keeping him in a well-lighted room. I am 
sure that the satisfactory results I have had 
the good fortune to achieve in the treatment 
of secondary malnutrition and anemia have 
been due in part to my insistence that the 
child sleep in a quiet, darkened room for two 
hours after the noonday meal. The energy 
expended in twelve hours by an active child 
is incalculable, and when a portion of this 
energy is reserved and the body fortified 
by rest and sleep during the middle of the 
day, it means a greatly diminished daily 
expenditure of strength units. 

CRYING 

It is well for the young infant to cry a 
little every day. Muscular movements in- 
volving a greater part of the body accompany 



Crying 293 

the act of crying and furnish exercise. Peri- 
stalsis is increased, as is often evidenced by 
a movement of the bowels occurring at the 
time, particularly when there is diarrhoea. 
In crying, deep breathing is necessary, the 
lungs are expanded, and the blood oxygen- 
ated. The well baby cries when frightened, 
or uncomfortable from hunger, soiled nap- 
kins, or inflamed buttocks. He cries from 
pain, from heat, from cold, from unsuitable 
clothing, and during difficult evacuation of 
the bowels. He also cries when displeased 
or angry. Authors are prone to refer to the 
diagnostic value of an infant's cry. It is 
my belief that characteristic cries are not 
to be depended upon sufficiently to give 
them a differential diagnostic dignity. Chil- 
dren slightly but painfully ill may cry in- 
cessantly for an hour or two. Thus, with 
intestinal colic, where the cry is loud and 
continuous until the child is relieved or until 
he falls asleep from exhaustion. Earache 
is not an infrequent cause. The habitual 
criers, the restless and vigorous crying, 
whining infants, are uncomfortable. With 
very few exceptions the trouble will be found 
in the intestinal tract. The well-trained, 



294 Cleanliness 

normal child, whose nourishment is suitable, 
is seldom troublesome. When well, all ba- 
bies are naturally good-natured and happy 
in their own way. Badly managed, spoiled 
infants often cry vigorously when left alone. 
When attention is given them, when they 
are taken up and talked to, the crying ceases. 
This readily tells us that pain or discomfort 
was not an element in causing the cry. In 
these infants, discipline, not medication, is 
needed. The management of the habitual 
crier involves the relief of the condition 
which causes the discomfort, or the most 
rigid discipline. 

CLEANLINESS 

Much has been said and written regarding 
the necessity of cleanliness so far as the child 
is concerned; but not only should the nurse 
and mother see that the baby is clean; they 
must be clean themselves. Immediately 
after every attention to the napkin the hands 
should be washed with hot water and soap 
and a stiff brush. This cleansing process 
must be repeated before the preparation of 
the food or any manipulation of the feeding 
apparatus. 



Cold Hands and Feet 295 

The child's attendants should not have 
decayed or neglected teeth. The tooth- 
brush should be an important article in the 
outfit of every nurse. She should take a 
tub-bath or sponge-bath daily. The hands 
and finger-nails of many nursery-maids will 
bear watching. 

COLD HANDS AND FEET 

The hands and feet of the infant should 
never be cold to the touch. This is a cause 
of much of his discomfort and restlessness. 
A very young child with poor circulation 
will be made much more comfortable by 
placing a hot-water bag at his feet. Bottles 
filled with warm water and wrapped in 
flannel will keep the upper extremities warm. 
In using the hot-water bags and bottles be 
sure that the water is not too hot. Severe 
burning accidents have resulted from care- 
lessness in this particular. 

An excellent means of keeping premature 
or delicate babies warm is in the use of the 
"Electrotherm" (Fig. 12). These small 
heaters are attached to an electric fixture, 
like a drop-light. A convenient size is from 



296 Flies and Mosquitoes 

ten to fifteen inches. It is placed between 
two or three thicknesses of blankets, upon 
which the infant lies in its basket or crib. 
The degree of heat can be regulated accord- 
ing to the amount of electricity turned on. 

FLIES AND MOSQUITOES 

The windows of the nursery should be 
screened so that flies and mosquitoes can- 
not enter. When out of doors the very 
young child should be protected by mos- 
quito-netting. Mosquitoes severely poison 
many children, and are of especial danger 
in that one variety is capable of inoculat- 
ing the child with malaria, the Plasmodium 
malarice being deposited along with the other 
poison. 

Flies, in addition to disturbing sleep, are 
a source of much danger which is but little 
appreciated. The fly enters the nursery and 
alights on the nipple of the nursing-bottle. 
This may take place while the child is resting 
for a second or two during his meal, as flies 
are very fond of the sweet milk which may 
adhere to the nipple; or the fly may alight 
upon the child's bread, or the prepared cereal, 



Germs 297 

or any article of food, particularly if there 
is a sweet element in it. The last place the 
fly rested before reaching the nursery we 
never know. It may have been on animal 
excrement, or tubercular sputum, or the 
infectious discharges of a typhoid-fever 
patient. In this way the flies' feet and legs 
are the means of transporting the germs of 
typhoid fever or diphtheria. Tuberculosis is 
unquestionably transferred in this way very 
frequently, minor ailments with still greater 
frequency. Flies are a source of danger in 
the house, and should be driven out or de- 
stroyed. There are fairly conclusive grounds 
for the belief that stable flies may be carriers 
of infantile paralysis. 

GERMS 

What need has the mother to know about 
germs? She, of all persons should know 
because nearly all the illnesses of infant and 
child life are due to invisible bodies, some so 
tiny that the most powerful microscope fails 
to detect them. 

The following is a list of some of the diseases 
which have been proven due to germs or 
bacteria : 



298 The Doctor 

Consumption (Tuberculosis), 

Meningitis, 

Cholera, 

Typhoid fever, 

Infantile paralysis, 

Diphtheria, 

Whooping-cough, 

Cholera infantum, 

Dysentery, 

Summer diarrhoea, 

Grippe, 

Pneumonia, 

Bronchitis. 

Scarlet fever, smallpox, measles, mumps, 
chicken-pox, and others are of germ origin, 
but the particular germ causing each disease 
has not been proven. 

Boiling, sterilizing, and the use of soap and 
hot water for scrubbing purposes, together 
with sunlight and fresh air and the destruc- 
tion of flies, mosquitoes, and other insects 
are the great means of combating germ life. 

WHEN TO SEND FOR THE DOCTOR 

This question is easily answered. Send 
for the doctor when there are any indica- 



First Aid to the Baby 299 

tions of illness in the child which the mother 
does not understand. It is better to be 
overcautious in this respect than to join the 
great number of mothers who are never free 
from the bitter, life-long regret, "The child 
might have been saved had he been treated 
in time " I know such mothers . 

There are two conditions in which the 
mother must not trust herself for a moment. 
These are summer diarrhoea and sore throat. 
"Only a summer diarrhoea," and "only a 
sore throat," and "only a teething diar- 
rhoea," have sacrificed the lives of hundreds 
of infants. 

Diphtheria is a very prevalent disease, 
and the successful treatment of it requires 
that the child be seen by the physician at 
the earliest possible moment. So, also, with 
summer diarrhoea. I have seen infants die 
in twelve hours with the disease. Calling 
a doctor early is a means not only of safety, 
but of economy. In the correction of slight 
ailments, grave ones are avoided. 

FIRST AID TO THE BABY 

Cuts. — Keep fingers, water, clothing, dust 
— everything away from the wound. Mix 



300 First Aid to the Baby 

one teaspoonful of tincture of iodine with 
the same quantity of alcohol, and paint this 
solution on the skin about the wound, from 
the very edges of the wound to at least two 
inches away on all sides, provided of course 
that the part injured will permit of this wide 
application. Then apply a freshly ironed 
piece of linen and a bandage. This dressing 
must be kept in place. 

Bruises and bumps. — Apply cloth wrung 
out in cold water. Change frequently. 

Sprains. — Wrap a bandage around the 
part and keep wet with cold water in frequent 
application. If the injured part is a lower 
extremity, keep it elevated on a plane with the 
body. 

Cuts, bruises, and sprains of consequence 
require the early attention of the family 
physician. 

Burns. — If the skin is merely reddened, 
apply vaseline or sweet oil on clean linen. If 
the skin is blistered or charred, do not apply 
any oily substance. Sprinkle boric acid 
powder over the parts and cover with clean 
linen until the physician arrives. 

Bites of animals. — Bites of animals are 
rarely serious. Hundreds of individuals are 



First Aid to the Baby 301 

bitten by dogs and cats every year without 
other harm than that of the wound inflicted. 
Apply at once on old linen a solution of one 
teaspoonful of carbolic acid in one pint of 
water or one ounce of boracic acid in one 
pint of water. Keep this dressing wet on the 
wound until a physician is seen. 

Bites of insects. — Bites of insects may be 
dangerous. Mosquitoes can transmit malaria 
and yellow fever. It is generally believed 
that the stable fly may transmit infantile 
paralysis. Insect bites, although innocent of 
great harm, cause a great deal of discomfort 
through itching and temporarily disfigure 
the child. Frequent applications of witch 
hazel are helpful in relieving the patient. 

Fever. — The onset of sudden fever is to be 
met by a dose of castor oil, one to two tea- 
spoonfuls, an enema (page 322) if there has 
been constipation, and a sponge bath (page 
114) with cool water. The sponging may be 
continued for from fifteen to twenty minutes. 

Colic. — An attack of colic is best relieved 
by an enema (page 322), by giving sips or 
teaspoonful doses of quite hot water. A 
soda mint tablet dissolved in one ounce of 
hot water and given in teaspoonful doses 



302 First Aid to the Baby 

every five minutes will relieve many cases. 
The food should be temporarily discontinued 
and water given. If the child has colic 
habitually it means that the food given needs 
the attention of a physician. 

Convulsions. — While awaiting the physi- 
cian place the baby in a warm bath and rub 
the body vigorously while in the bath. If 
mustard is at hand add two teaspoonfuls to 
the water used. The great majority of 
convulsions are due to indigestion and con- 
stipation. Give the baby an enema as soon 
as possible, perhaps while in the bath. As 
soon as the baby can swallow give two 
teaspoonfuls of castor oil. For a few days 
following, a greatly reduced diet should be 
given. 

Earache. — 1st. Drop warmed sweet oil 
into the ear. Test your own ear first to insure 
its not being too hot. 

2d. Rest the affected side on a hot-water 
bag. 

3d. Syringe the ear (page 322) with water 
at 110 F. If a thermometer is not at hand, 
have the water quite warm and test the heat 
of the water in your own ear before using. 

Nose-bleed. — The child should sit erect, not 



First Aid to the Baby 303 

lie down. The nose should be firmly com- 
pressed between the thumb and finger for 
several minutes. The tips of the thumb and 
finger should touch the lower portion of the 
nasal bones. After the bleeding is controlled 
in this way, a small piece of ice should be 
wrapped in a handkerchief and held against 
the affected side. Repeated hemorrhage 
usually means that an ulcer is present in the 
nostrils and needs active treatment. 

Foreign bodies swallowed. — Foreign bodies 
swallowed by infants and young children 
rarely cause harm. Do not give a laxative. 
Give starchy substances such as oatmeal, 
potato, cornmeal mush, substances which 
may form a semi-solid mass in the intestine 
in which the object swallowed may become 
imbedded and carried forward. 

Foreign bodies in nose and ear. — A foreign 
body in either nostril may sometimes be 
removed by making pressure over the un- 
obstructed nostril and then directing the 
child to blow the nose vigorously. 

Substances not thus removed, as well as 
foreign bodies in the ear, should be removed 
only by a physician. 

Prickly heat. — Prickly heat is best treated 



304 First Aid to the Baby 

by sponge baths of bicarbonate of soda, one 
tablespoonful to two quarts of water. Do not 
rub the skin in drying. Several times a day 
dust the skin thoroughly with a powder 
composed of equal parts of powdered starch 
and oxide of zinc, obtained at the druggist's. 
Children with prickly heat should wear thin 
gauze or linen underwear. Wool should not 
be worn. 

Croup. — There are two kinds of croup, 
catarrhal or spasmodic and diphtheritic or 
membranous croup. 

Croup always calls for the immediate 
attention of a physician. While waiting for 
the doctor, give the patient a teaspoonful of 
syrup of ipecac to be repeated in 15 minutes, 
if vomiting does not occur. The child is much 
relieved by vomiting, if the case is one of 
spasmodic croup. Steam inhalation from a 
croup kettle or a tea-kettle are of much 
service. Care must be exercised not to burn 
the child. 

Sore throat. — A mother must never at- 
tempt to treat a sore throat in a child. 
Diphtheria usually begins with low fever 
and a slight sore throat. A physician should 
be called in every case of sore throat in a child. 



Patent Medicines 305 

I could give many instances in which children 
have died with diphtheria because of neg- 
lected "home- treated" sore throat. 

The swallowing of poisons. — Unfortunately 
children are sometimes given the wrong 
medicine, or given some poisonous substance 
instead of the medicine intended. I have 
known children to swallow poisonous tablets 
and pills intended for adults. Under such 
circumstances the child should always be 
made to vomit. This can be done by " gag- 
ging " the child through forcing the clean index 
finger low in throat. If syrup of ipecac is at 
hand two teaspoonfuls may be given, which 
will be sufficient to produce active vomiting. 
The physician must be called at once in all 
cases of poisoning. 

PATENT MEDICINES 

Patent medicines should form no part of 
the nursery outfit. The mother's home 
remedies should all be approved by a physi- 
cian. Cough mixtures and soothing syrups, 
the advantages of which are so faithfully 
portrayed in the popular magazines and 
religious periodicals, are often very harmful. 



306 Summer Resorts 

Most of them contain alcohol, opium, or 
morphine. Time and again I have seen 
children drugged to the point of stupor by 
these remedies. 

SUMMER RESORTS 

Where to take the child for the summer 
is a vexed question which arises once a year 
in many households. Several years of obser- 
vation of a great many children who have 
spent the summer out of town have led me 
to the following conclusions : 

1. The most desirable summer outing: 
the first half of the season at the seashore, 
the remainder inland, preferably in the 
mountains. 

2. The next in order of desirability: in- 
land, preferably the mountains for the entire 
summer. 

3. The least desirable: the seashore for 
the entire summer. 

I do not wish it understood that many 
children will not do well at the seashore if 
kept there the entire summer; some, indeed, 
improve wonderfully; but among my own 
patients I have been repeatedly impressed 






Summer Resorts 307 

with the disadvantages of a prolonged outing 
by the sea. The seashore children, as a rule, 
do not return to the city in the fall with the 
vigor, appetite, and general robustness which 
characterize those who return from the 
mountains. I refer only to New York chil- 
dren, whose home is a seaport, and who 
thrive best when given the advantage of a 
complete change to the dry, invigorating air 
of the mountains. Children with catarrhal 
tendencies, adenoids, bronchitis, and rheu- 
matism, and those convalescent from pneu- 
monia, should not go to the seashore. 

In selecting an inland resort, the moun- 
tains, by which we understand an elevation 
of from fifteen hundred to two thousand feet, 
are not always necessary. The place selected, 
however, should have an elevation of at least 
six hundred feet, and should not be within 
sixty miles of the coast. Children who are 
subject to rheumatism and bronchitis do best 
on a sandy soil, in a dry climate, with the 
sleeping rooms above the ground floor. 

Another point to be considered in this 
connection is the kitchen facilities which 
will be provided for the preparation of the 
child's food. As a rule, the larger hotels 



308 Drug-Giving 

refuse the right of way to the kitchen; or, 
if they do not, it is at the expense, of many 
material attentions to the chef. I find that 
mothers are given much more latitude as to 
these matters in the smaller hotels and board- 
ing-houses. The proper preparation of a 
child's food in the cramped quarters of the 
sleeping apartment is not impossible, but it is 
very difficult. 

Before selecting a summer home, the 
drainage, the milk, and the water supply 
must be considered. If the parents possess 
the means, a cottage should be rented, which 
will insure them all the comforts of home. 
Country well water or spring water should 
always be boiled before using. 

DRUG-GIVING 

Drugs are of service only in the hands of 
those who are trained in their use. Mothers 
often acquire the habit of treating their chil- 
dren. Self -prescribing is greatly overdone 
in this country among all classes. Many 
people know just enough about medicines 
to be dangerous members of society. The 
proprietary cough mixtures, soothing syrups, 
teas, carminatives, etc., are often injurious. 



The Daily Outing 309 

They usually contain opium, — a drug which 
a mother should never think of giving her 
baby on her own responsibility. It is not 
at all uncommon in hospital work to have 
children admitted in an opium stupor which 
resists all treatment for hours. 

While the habit of promiscuous drug- 
giving is to be condemned, the mother is 
not supposed to remain inactive while await- 
ing the arrival of the physician ; a preliminary 
dose of castor-oil in diarrhoea, or syrup of 
ipecac in croup, or rhubarb and soda when 
there is a furred tongue in indigestion, will 
always be in order. The mother may have 
her home remedies, but the physician must 
instruct her in their use. 

THE DAILY OUTING 

The baby should not go out in stormy 
weather. If under one year of age he should 
not go out if the temperature is below 20° F. 
During the midday heat of summer the baby 
is better off in the largest and coolest room 
in the house or on a shady veranda. On very 
windy days the outing should be postponed. 
When the snow is melting in large quantities 
the baby is better off indoors. 



310 Indoor Airing 

INDOOR AIRING 

For this purpose the child is dressed as 
for the daily outing. All the windows of 
the nursery or some other large room are 
opened, on one side of the room only. The 
doors should be closed, so that currents of 
air are avoided. The child is placed in his 
carriage, suitably covered, and wheeled about 
the room for an hour or two. This, if done 
twice daily, answers almost as well as the 
actual outing. 

This method will be found very useful in 
"winter babies" — those born during the late 
fall or winter months. The indoor airing 
may be given for a week or more, before he 
is taken out. By this means the child is 
gradually accustomed to a change of the 
temperature from that of the average living- 
room to that of out-of-doors, and will not 
be harmed when he is finally taken out. 
After an illness, it will afford an earlier means 
of returning to the daily outing. This method 
of giving a child fresh air will be found useful 
with very delicate children, who, by reason 
of their condition, may be unable to go out 
during the winter months for several weeks 



Children's Parties 311 

at a time. There are, however, but few days 
during the winter that are too cold or too 
stormy for the indoor airing. 

CHILDREN'S PARTIES 

Parties for children under the sixth year 
of age are to be discouraged. The import- 
ant features of a child's party are entertain- 
ment and the "banquet." There are two 
features of child life that are important to 
guard against — excitement and injudicious 
feeding. Exciting play and unusual articles 
of food at an unusual time appear to be a 
necessary part of a so-called children's party. 
The bringing together of children of tender 
age is further to be discouraged because it 
increases their liability to contract the con- 
tagious diseases from which every child 
should be protected to the full extent of our 
ability. 

Not long since a patient — a little boy four 
years old — invited fourteen little boys and 
girls of corresponding ages to celebrate his 
birthday. The little host was more gen- 
erous than was his wont ; he gave more than 
the banquet! The night of the birthday 



312 Baskets for Early Exercise 

party he was very uncomfortable. The 
following day he developed chicken-pox. In 
due course of time twelve of the fourteen 
little guests came down with chicken-pox. 
They were fortunate that it was only chicken- 
pox; it might have been scarlet fever or 
diphtheria. 

I regret that I have not kept a record 
of the acute illnesses that have followed 
children's parties under my immediate • ob- 
servation. Acute indigestion, diarrhoea, con- 
vulsions, and all of the contagious diseases 
of childhood would be found in generous 
numbers in such a record. 

BASKETS FOR EARLY EXERCISE 

It is a great mistake to have the infant 
constantly in arms. The first baby suffers 
more in this respect than later children. 
When the child is held, there is always a 
tendency to make him sit on the arm or knee 
without proper support, or to toss about or 
handle him regardless of consequences. The 
bones and ligaments of the spinal column 
are not sufficiently developed to bear the 
weight of the heavy head and trunk, and, 



Baskets for Early Exercise 313 

as a result, as the child grows older, spinal 
curvature and other deformities not infre- 
quently follow. By urging him to stand on 
the lap the legs are used more than is advis- 
able, and we find bow-legs or knock-knees 
very prevalent. 




FIG. 19. BASKET FOR EARLY EXERCISE 

A large clothes-basket, in which a thick 
blanket has been placed (see Fig. 19) , furnishes 
a safe and satisfactory playground. For 
the first few months the child will rest on 
his back and amuse himself in his own pecu- 
liar way. When he can sit up, supported 
by a pillow at his back, the basket gives him 
plenty of room for toys and other baby re- 
quirements. In it the baby is practically 
safe. He is not apt to be injured by young 



314 Night Terrors 

members of the family in rough play. He 
cannot crawl to the stove to be burned, and 
is in no danger of rolling down-stairs. When 
he can stand and begins to walk, the basket 
period is at an end. 

NIGHT TERRORS 

The child awakens suddenly from sleep, 
cries out with fear, and begs to be protected 
from men and animals, which he imagines 
are trying to injure him. In some cases the 
nurse and immediate relatives of the family 
will not be recognized. The seizures may 
occur quite regularly every night until the 
cause is removed. Other children may have 
but one or two attacks in a week. The 
seizures are usually due to a disordered diges- 
tive tract in a nervous child. Adenoids and 
enlarged tonsils are considered by some to 
act as a predisposing cause. Anxiety re- 
garding school duties, or overwork at school 
may help to bring on an attack; worms may 
also be a cause. My cases have all been due 
either to acute or chronic digestive disturb- 
ances in nervous children. A boy patient 
twelve years of age has had two attacks 



Scales for Weighing 315 

every year, with one exception, since he was 
six years old. These attacks always occur 
on the nights after Christmas and his birth- 
day, after indulgence in all sorts of unsuitable 
articles of food. 

During the attack the child must be treated 
with gentleness; scolding makes matters 
worse. If possible, he should be induced to 
go to sleep; oftentimes a change to the bed 
of the nurse or mother for the remainder of 
the night will be all that is necessary; or a 
light may be left burning in the room. The 
attacks may usually be prevented by a suit- 
able diet. The evening meal should be very 
light — a cereal with milk and a little stewed 
fruit is sufficient. This light supper has 
relieved several of my patients of habitual 
night terrors. Constipation is often an im- 
portant factor, and when present requires 
treatment before relief is to be expected. 

SCALES FOR WEIGHING 

A scale for weighing the baby is a very 
necessary adjunct to the nursery furnishings. 

There are, on the market, several varieties 
of scales for weighing the baby, which are 
known as "baby scales." The usual con- 



316 Scales for Weighing 

struction is that of a basket, into which the 
baby is placed, supported by a rod which 
rests upon a spring. A needle indicates on 
a dial the weight of the child. The use of 




FIG. 20. SCOOP AND PLATFORM SCALES FOR WEIGHING 

these scales is not to be advised. They get 
out of order easily, are expensive, and with 
a vigorous, kicking, crying baby, the rapid 
oscillations of the needle often prevent the 
weight being read with any degree of accu- 
racy. Further, their weight capacity is but 
twenty pounds. When the child's weight 
reaches this figure, it necessitates the pur- 
chase of other scales. The scoop and plat- 
form scales used by grocers (see Fig. 20) 



The Exercise Pen 317 

answer the purpose far better than any 
others. They can be bought for about 
$3.50, l do not get out of order, and weigh 
correctly from one-half ounce to two hun- 
dred and eighty pounds. The infant rests 
on his back in the scoop during the weigh- 
ing process. Older children stand on the 
platform. 

THE EXERCISE PEN 

In a previous chapter, in speaking of cold 
and how children were exposed to influences 
which might bring about what is known as a 
"cold," the custom of allowing a child to sit 
on the floor is referred to. 

To keep a child from eight to twenty-four 
months of age off the floor during the winter 
months, and thereby prevent his taking cold, 
is a very difficult matter. In fact, with 
active children who are learning to walk, 
or who have just learned to walk, it is prac- 
tically impossible. During this season of the 
year there is always a current of cold air near 
the floor, and allowing the child to creep on 

1 Metropolitan Hardware Co., Church and Vesey Sts., 
N. Y. C. 



The Exercise Pen 319 

the floor in winter, even if it is protected by 
rug and pillows, is one of the surest ways of 
taking cold. If he is allowed to walk on the 
floor he is very sure to sit down in a very 
few minutes. If he is not allowed to creep and 
walk about at will he will not get the proper 
exercise, and will show faulty development; 
for such cases I have found the exercise pen 
(see Fig. 21) of immense service. After being 
dressed, washed, and fed, the infant is placed 
in the pen on a rug or quilt, toys are given 
him, and the door closed. He can now roam 
about at will, stand up, sit down, roll, creep, 
or walk without danger of physical harm 
from rolling down-stairs, being burned, or 
being stepped on. He is thus given an 
opportunity for active exercise without a 
possible chance of injury. 

A young mother of two children will take 
her "pen" into the country in the summer 
and place it in the shade for use while the 
dew is on the grass. In case the nursery is 
small it can be made so as to fit over the 
nursed bed and consequently does not re- 
quire any additional space. In a large 
nursery it can be placed permanently in 
one corner of the room, thus avoiding the 



320 Don'ts 

trouble of putting it up and taking it 
down. 

The pen can be made of any size, — 4 x 6 ft. 
is probably the most convenient, although 
several made 4 x 4 ft. are in use. It is so con- 
structed as to be taken apart and put to- 
gether in a few moments, iron tenon hooks 
and iron mortices being used to hold the parts 
together. The floor may be made of any 
thin material. One-quarter inch pine boards 
nailed together so that the floor will be com- 
posed of two thicknesses, or papier-mache 
supported by narrow strips of board, may 
be used. The floor is supported by strips 
of board about one-half by two inches, which 
are fastened to the inner side of the end- 
pieces. 

DON'TS 

Do not kiss the baby on the mouth or 
allow your friends to do so. 

Do not give soothing syrups or paregoric. 

Do not give proprietary cough medicines. 

Do not fail to secure the best milk you can 
afford to buy. 

Do not allow flies to rest on feeding bottle 
or nipple. 



Don'ts 321 

Do not fail to wash the hands before pre- 
paring the food. 

Do not neglect to properly cleanse the 
bottle and nipple. 

Do not allow the milk bottle to remain un- 
covered or off the ice. 

Do not fail to keep the food on the ice 
after it is prepared. 

Do not feed the baby at irregular intervals. 

Do not fail to change the napkin as soon 
as it is soiled. 

Do not fail to protect the baby from flies 
and mosquitoes by suitable mosquito netting. 

Do not give the baby a pacifier. 

Do not place the spoon or nipple to the 
lips before giving it to the child. 

Do not allow the baby to pick objects from 
the floor and place them in his mouth. 

Do not allow the baby to go one day 
without a bowel movement. 

Do not neglect the daily care of the mouth. 

Do not excite the baby during or immedi- 
ately after feeding. 

Do not raise the baby without supporting 
the back. 

Do not neglect to powder all folds of the 
skin. 

21 



322 General Instructions 

Do not neglect to keep the ice-box clean 
and filled with ice. 

GENERAL INSTRUCTIONS 

How to give an enema. — Make a suds of 
water and Castile soap. Pour one pint water 
into the bag of a fountain syringe. Introduce 
the black rubber tip into the anus. Raise 
the bag two feet above the child's head and 
allow the water in part or entire to pass into 
the intestine. 

How to cleanse the eyes. — Dip clean absorb- 
ent cotton in boracic acid solution, tea- 
spoonful to one glass of water (dissolved with 
hot water) ; the solution may be used cool or 
lukewarm. Use a fresh piece of cotton for 
each eye. 

How to cleanse the baby's nose. — Wrap 
loosely a bit of absorbent cotton on a wooden 
toothpick. Dip the cotton in vaseline and 
with the baby's head held firmly introduce 
the cotton into the nostrils and through very 
gentle manipulation remove the crusts and 
secretions that may have formed there. 
Use fresh cotton for each nostril. 

How to syringe the ears. — Necessary articles : 



Food Formulas 3 2 3 

A two-quart fountain syringe and a small 
basin. 

The child should be wrapped in a sheet 
with the arms bound to the side. He should 
rest on his back on the bed or couch. The 
basin protected by a towel is placed under 
the ear. Into the bag of the syringe is poured 
the solution to be used for the douching. 
The bag is held three feet above the child's 
head. The small black rubber tip is held 
about one-fourth inch from the orifice of the 
ear canal and the solution allowed to flow. 
The ear should be drawn slightly backward as 
this straightens the canal and allows of a 
freer flow of water. 

FOOD FORMULAS 

Beef-juice. — Take a round steak, cut into 
pieces the size of a horse-chestnut, place in 
a buttered pan in a hot oven, and bake 
for fifteen minutes; remove from the pan 
and press out the blood with a meat-press. 
Or, broil round steak very rare, cut into 
small pieces, place in a meat-press, and 
press out the blood; add a little salt. 

Beef, mutton, and chicken broth. — Take one 
pound of meat free from fat, cook for three 



324 Food Formulas 

hours in one quart of water, adding water 
from time to time, so that when the cooking 
is completed there will be one pint of broth. 
When the broth is cool, remove the fat, 
strain and add salt. 

Scraped beef. — Broil round steak slightly 
over a brisk fire. Split the steak and scrape 
out pulp, using a dull knife. 

Egg-water. — The white of one egg, thor- 
oughly beaten in one pint of cold boiled 
water, strain, add a pinch of salt. 

Oatmeal jelly. — Oatmeal, four ounces; 
water, one pint; boil for three hours in a 
double boiler, water being added, so that 
when the cooking is completed a thin paste 
will be formed. This while hot is forced 
through a colander to remove the coarser 
particles. When cold, a semi-solid mass will 
be formed. 

Wheat jelly and barley jelly. — Wheat jelly 
and barley jelly are made in the same way 
as oatmeal jelly, using cracked wheat or 
barley grains. 

Barley-water. — Robinson's barley flour or 
Cereo Co.'s barley flour, one rounded table- 
spoonful ; water, one pint ; boil thirty minutes, 
strain, add water to make one pint. 






Food Formulas 325 

Rice-water. — Rice, one tablespoonf ul ; water 
one pint ; boil three hours, adding water from 
time to time, so that there is one pint of rice- 
water at the end of three hours. 

Dextrinized barley-water. — Robinson's bar- 
ley flour or Cereo barley flour, three table- 
spoonfuls; water, one pint; boil twenty 
minutes, add water to make a pint. When 
lukewarm (ioo° F.) add one teaspoonful of 
Cereo, strain; this changes the starch into 
dextrinized maltose. 

Oatmeal-water. — Oatmeal, one tablespoon- 
ful; water, one pint; cook three hours and 
add water to make one pint. 

Imperial granum-water . — Imperial granum, 
one tablespoonf ul ; water, one pint ; cook thirty 
minutes and add water to make one pint. 

Whey. — Put one pint of fresh milk into a 
saucepan and heat it lukewarm, not over 
ioo° F.; then add two (2) teaspoonfuls of 
Fairchild's essence of pepsin and stir just 
enough to mix. Let it stand until firmly 
jellied, then beat with a fork until it is finely 
divided, strain, and the whey, the liquid 
part, is ready for use. 

Junket. — To one pint of fresh milk add 
one tablespoonful of essence of pepsin or a 



326 Food Formulas 

junket tablet, and two teaspoonfuls of sugar. 
Allow it to stand over a fire until the tem- 
perature is ioo° F.; then add vanilla as a 
flavoring and allow it to stand until the curd 
is set, when it should be placed upon ice. 

Cornstarch pudding. — Dissolve one table- 
spoonful of cornstarch in a little milk. Heat 
one pint of milk to nearly boiling point. Add 
cornstarch slowly, then one tablespoonful of 
sugar and stir until it thickens. When cool 
add 5 drops of flavoring. 

Soft custard. — Heat one cup of milk to boil- 
ing point. Add one yolk of egg well beaten, 
1 3^2 tablespoonfuls of sugar and a pinch of 
salt. Cook in a double boiler, stirring until 
it thickens. Strain. When cool, add 5 drops 
of flavoring. 



THE END 



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By AMY ELIZABETH POPE, Author, with 

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